Bleeding, Hemorrhage
Conditions
Keywords
cardiac surgery, bleeding, point of care testing, POCT, algorithm based therapy
Brief summary
The aim of this study is to develop a coagulation algorithm based on Quantra POCT for the treatment of coagulopathic cardiac surgery patients.
Detailed description
In order to perform a targeted coagulation therapy during intra- and postoperative care of cardiosurgical patients, it is necessary to know the hemostatic potential. After blood samples have been taken for coagulation diagnosis, they are usually sent to the central laboratory. After analysis and validation, the results are transmitted electronically. The loss of time due to sample transport, analysis and provision of the results prolongs the time required to derive therapeutic measures. In recent years, point of care testing (POCT) devices for the diagnosis of coagulopathic patients have become increasingly important. In our clinic, POCT devices have been routinely used for intra- and postoperative targeted coagulation therapy for years. These include the ROTEM delta and Multiplate. For analysis, a whole blood sample is pipetted together with test reagents. Depending on the selected reagent, different parts of the coagulation cascade can be evaluated and, depending on this, an appropriate therapy can be derived. A coagulation algorithm developed in our clinic is based on these measurement results and has been used successfully for years for perioperative coagulation management. This algorithm requires additional information on the platelet function, which is also carried out as standard on the bed side using multi-plate analysis as POCT. A new system for whole blood analysis has recently become available on the market. The Quantra from HemoSonics also allows the analysis of a whole blood sample on the bed side. Due to the cassette structure, the time-consuming and potentially error-prone pipetting of a whole blood sample is no longer necessary. The aim of this study is to develop a coagulation algorithm based on Quantra POCT for the treatment of coagulopathic cardiac surgery patients.
Interventions
Hemotherapy based on Quantra-Algorithm
Hemotherapy based on Basic-Algorithm
Sponsors
Study design
Eligibility
Inclusion criteria
\>18 years elective operation with cardiac bypass
Exclusion criteria
participation on another study
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Bloodloss | From finishing operation until 24 hours postoperative | Cumulative bloodloss directly after surgery for 24h Determined by cumulative volume of all drains in millilitres |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Multiplate results | During operation within 24 hours postoperative | Determin platelet function with TRAP test |
| Time saving by using a cassette | During operation within 24 hours postoperative | Influence of a cassette structure in comparison to pipetting with regard to the temporal availability of the measurement results |
| Use of blood products | During operation within 24 hours postoperative | Cumulative volume of administered fresh frozen plasma, platelet infusion and packed red blood cells in mililitres |
| Correlations of parameters between POCT and laboratory parameters. | During operation within 24 hours postoperative | Quick |
| Thromboembolic complications | During operation within 24h postoperative | Thromboembolic complications |
| Comorbidities | 15 years before operation | Comorbidities |
| Coagulationfactos and procoagulant drugs | During operation within 24 hours postoperative | Cumulative usage of prothrombin complexe concentrate measured in international units, fibrinogen measured in gramm, tranexamic acid measured in gramm, desmopressin measured in microgramm, Calcium measured in gramm, activated factor VII measured in international units |
Countries
Germany