Rotational Thromboelastometry Guided Transfusion Protocol Versus Classic Transfusion Protocol in Reducing Blood Components Transfusion in Adult Patients Undergoing Elective Cardiac Surgery: A Randomized Clinical Trial

Aim: This study assessed the role of rotational thromboelastometry (ROTEM)-guided transfusion protocol in reducing blood product transfusion during cardiac surgeries.  
Methodology: This randomized, single-blind trial enrolled 32 patients who were randomized to receive either the ROTEM-guided transfusion protocol or the classic transfusion protocol. The primary outcome was the need for blood component transfusion after bypass and during the initial 24 postoperative hours. Secondary outcomes included residual heparin after reversal with protamine and blood loss postoperatively during the first 24 hours.
Results: While differences in red blood cell transfusions post-bypass and within the first 24 hours postoperatively were observed, they were statistically non-significant. Fresh frozen plasma (FFP) transfusions differed post-bypass, without statistical significance. However, the ROTEM group had a statistically significant reduction in FFP units within the first 24 hours postoperatively (P<0.001). The number of platelet units transfused in the initial 24 hours postoperatively showed a difference between both groups, but it was statistically non-significant. However, ROTEM significantly reduced platelet use post-bypass (P<0.001). Blood loss also differed between groups but was statistically non-significant.
Conclusions: The application of ROTEM-guided transfusion protocol reduces blood product transfusion (FPP and platelets) in patients undergoing elective cardiac surgery on cardiopulmonary bypass.