ORIGINAL ARTICLESUse of fibrin-based thromboelastometry for cryoprecipitate transfusion in cardiac surgery involving deep hypothermic circulatory arrest during cardiopulmonary bypassLee, Sang Hyuna; Lee, Sangmin Ma; Kim, Chung Sua; Cho, Hyun Sunga; Kim, Gaab Sooa; Gwak, Mi Sooka; Chang, Choo Hoona; Sung, KiickbAuthor Information aDepartment of Anesthesiology and Pain Medicine, Samsung Seoul Hospital, Korea bDepartment of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea Received 9 June, 2010 Accepted 14 July, 2010 Correspondence to Sangmin M. Lee, MD, PhD, Professor, Department of Anesthesiology and Pain Medicine, Samsung Seoul Hospital, Samsung Medical Center, Sungkyunkwan University School of Medicine, #50 Ilwon-Dong, Gangnam-Gu, Seoul 135-710, Korea Tel: +82 2 3410 0362; fax: +82 2 3410 0361; e-mail: [email protected] Abstract of this paper was presented as an exhibition poster at Society of Cardiovascular Anesthesiology SCA 2010. Blood Coagulation & Fibrinolysis: October 2010 - Volume 21 - Issue 7 - p 687-691 doi: 10.1097/MBC.0b013e32833e4228 Buy Metrics Abstract We aimed to assess the predictive value of fibrin-based thromboelastometry performed before weaning from cardiopulmonary bypass (CPB) for cryoprecipitate administered to correct the bleeding diathesis after CPB involving deep hypothermic circulatory arrest. Eleven patients undergoing aortic surgery were enrolled. The arterial blood was withdrawn before skin incision, 30 min before CPB weaning (Cweaning), 5 min after protamine reversal (Preversal) and at closure of the sternum to run intrinsically activated INTEM, heparinase-treated HEPTEM, extrinsically activated EXTEM and platelet-inhibited FIBTEM analysis, platelet count, fibrinogen, prothrombin time (international normalized ratio) and activated partial thromboplastin time. The predicted value of FIBTEM A10 obtained during CPB for cryoprecipitate transfusion at Preversal was calculated. The cut-off points for FIBTEM A10 to reflect fibrinogen of 200 mg/dl at Preversal were 5 mm (P = 0.15). FIBTEM A10 at Preversal and Cweaning showed correlations as follows: FIBTEM A10 at Preversal = 0.02 + 1.42 × FIBTEM A10 at Cweaning (r2 = 0.80). The cut-off value for FIBTEM A10 at Cweaning to determine whether to prepare cryoprecipitate in advance during CPB was calculated to be 3 mm, and the positive and negative predictability for FIBTEM A10 of 3 or less versus more than 3 at Cweaning for the necessity of cryoprecipitate transfusion at Preversal (A10 ≤ 5 versus > 5) were 100 and 80%, respectively. This study showed that fibrinogen reflected in FIBTEM during pump can be used to estimate FIBTEM after Preversal and the amount of cryoprecipitate needed for replacing mainly the fibrinogen could be predicted with high sensitivity and specificity. © 2010 Lippincott Williams & Wilkins, Inc.