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Thromboelastometry (ROTEM®) in children: age-related reference ranges and correlations with standard coagulation tests

Oswald, E. ; Stalzer, B. ; Heitz, E. ; Weiss, M. ; Schmugge, M. ; Strasak, A. ; Innerhofer, P. ; Haas, T.

In: British Journal of Anaesthesia, 2010, vol. 105, no. 6, p. 827-835

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    Titre
    • Thromboelastometry (ROTEM®) in children: age-related reference ranges and correlations with standard coagulation tests
    Auteur
    • Oswald, E.. Department of Anaesthesiology and Critical Care Medicine, Innsbruck Medical University, Innsbruck, Austria
    • Stalzer, B.. Department of Anaesthesiology and Critical Care Medicine, Innsbruck Medical University, Innsbruck, Austria
    • Heitz, E.. Department of Anaesthesiology and
    • Weiss, M.. Department of Anaesthesiology and
    • Schmugge, M.. Department of Haematology, Zurich University Children's Hospital, Zurich, Switzerland
    • Strasak, A.. Department of Medical Statistics, Informatics and Health Economics, Innsbruck Medical University, Innsbruck, Austria
    • Innerhofer, P.. Department of Anaesthesiology and Critical Care Medicine, Innsbruck Medical University, Innsbruck, Austria
    • Haas, T.. Department of Anaesthesiology and Critical Care Medicine, Innsbruck Medical University, Innsbruck, Austria
    Type de document
    • Postprint
    Langue
    • Anglais
    Publié dans
    • British Journal of Anaesthesia, 2010, vol. 105, no. 6, p. 827-835. Oxford University Press
    Autre version électronique
    Identifiant OAI-PMH
    • oai:doc.rero.ch:304301
    Summary
    Background The small sample volume needed and the prompt availability of results make viscoelastic methods like rotational thromboelastometry (ROTEM®) attractive for monitoring coagulation in small children. However, data on reference ranges for ROTEM® parameters in children are scarce. Methods Four hundred and seven children (ASA I and II) undergoing elective surgery were recruited for this prospective, two-centre, observational study. Subjects were grouped as follows: 0-3, 4-12, 13-24 months, 2-5, 6-10, and 11-16 yr. Study objectives were to establish age-dependent reference ranges for ROTEM® assays, analyse age dependence of parameters, and compare ROTEM® data with standard coagulation tests. Results Data from 359 subjects remained for final analysis. Except for extrinsically activated clot strength and lysis, parameters for ROTEM® assays were significantly different among all age groups. The most striking finding was that subjects aged 0-3 months exhibited accelerated initiation (ExTEM coagulation time: median 48 s, Q1-Q3 38-65 s; P=0.001) and propagation of coagulation (α angle: median 78o, Q1-Q3 69-84o; P<0.001) and maximum clot firmness (median 62 mm, Q1-Q3 54-74 mm), although standard plasma coagulation test results were prolonged (prothrombin time: median 13.2 s, Q1-Q3 12.6-13.6 s; activated partial thromboplastin time: median 42 s, Q1-Q3 40-46 s). Lysis indices of <85% were observed in nearly one-third of all children without increased bleeding tendency. Platelet count and fibrinogen levels correlated significantly with clot strength, and fibrinogen levels correlated with fibrin polymerization. Conclusions Reference ranges for ROTEM® assays were determined for all paediatric age groups. These values will be helpful when monitoring paediatric patients and in studies of perioperative coagulation in children