ROTEM (rotational thromboelastometry) driven transfusion strategy reduces transfusional needs during thoracoabdominal aortic aneurysm open repair: a propensity score matched study.

Background Open repair of thoracoabdominal aortic aneurysm (TAAA) is a challenging procedure, associated with high rates of perioperative bleeding and blood products transfusion. A large intraoperative volume transfusion has been associated with higher in-hospital mortality and prolonged mechanical ventilation. We performed a propensity score matched study to assess if the introduction of a rotational thromboelastometry (ROTEM)- based transfusion strategy reduces the need for allogenic blood transfusions and affects morbidity in patients undergoing open TAAA repair. Materials & Methods All patients undergoing open TAAA repair at our institute between 2009 and 2017 were included. Until 2016, a protocol based on estimated blood losses and conventional coagulation tests was used. After March 2016 a ROTEM guided transfusion protocol was developed and adopted. To account for selection bias, a propensity score matching was performed. Results Patients managed with ROTEM received less red blood cells units (3.5 [0-11] vs 4 [0-17]; p= 0.026) and a lower volume of fresh frozen plasma (286±496 vs 2050±1120; p<0.001). In addition, fewer patients received fresh frozen plasma (35% vs 97%; p<0.001). Patients in the ROTEM group showed a significant decrease in the occurrence of pulmonary complications (44% vs 83%; p= 0.01). Cost analysis shown a relevant reduction of per-patient expense after the introduction of the ROTEM (780±569 € vs 1285±851 €, p<0.001). Conclusions A ROTEM-guided transfusion strategy significantly limited the quantity of transfused blood products during open TAAA repair, improving clinical outcomes while reducing costs, allowing for a better resource distribution in settings where blood losses are relevant.