Effect of ultrafiltration on whole blood coagulation profile during cardiopulmonary bypass in cardiac surgery: a retrospective analysis
Background Ultrafiltration (UF) would enhance coagulation profiles by concentrating coagulation elements during cardiopulmonary bypass (CPB) for cardiac surgery. Methods We retrospectively reviewed electronic medical records of 75 patients who had undergone cardiac surgery with rotational thromboela...
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| Format: | Article |
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Korean Society of Anesthesiologists
2024-04-01
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| Series: | Korean Journal of Anesthesiology |
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| Online Access: | http://ekja.org/upload/pdf/kja-23698.pdf |
| _version_ | 1827302533377294336 |
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| author | Jaemoon Lee Dong-Kyu Lee Won-Kyoung Kwon Sookyung Lee Chung-Sik Oh Klaus Görlinger Tae-Yop Kim |
| author_facet | Jaemoon Lee Dong-Kyu Lee Won-Kyoung Kwon Sookyung Lee Chung-Sik Oh Klaus Görlinger Tae-Yop Kim |
| author_sort | Jaemoon Lee |
| collection | DOAJ |
| description | Background Ultrafiltration (UF) would enhance coagulation profiles by concentrating coagulation elements during cardiopulmonary bypass (CPB) for cardiac surgery. Methods We retrospectively reviewed electronic medical records of 75 patients who had undergone cardiac surgery with rotational thromboelastometry-based coagulation management in a university hospital and analyzed the UF-induced changes in the maximum clot firmness (MCF) of extrinsically activated test with tissue factor (EXTEM) during CPB in 30 patients. Results The median volume of filtered-free water was 1,350 ml, and median hematocrit was significantly increased from 22.5% to 25.5%. As the primary measure, UF significantly increased the median MCF-EXTEM from 48.0 mm to 50.5 mm (P = 0.015, effect size r = 0.44). The area under the receiver operating characteristic curve pre-UF MCF-EXTEM for discrimination of any increase of MCF-EXTEM after applying UF was 0.89 (95% CI [0.77, 1.00], P < 0.001), and its cut-off value was 50.5 mm (specificity of 81.8% and sensitivity of 84.2% in Youden’s J statistic). In the secondary analyses using the cut-off value, UF significantly increased the median MCF-EXTEM from 40.5 mm to 42.5 mm in 18 patients with pre-UF MCF-EXTEM ≤ 50.5 mm. However, it did not increase MCF-EXTEM in 12 patients with pre-UF MCF-EXTEM > 50.5 mm. There was a significant interaction between pre-UF MCF-EXTEM values and applying UF (P < 0.001 for the subgroup, P = 0.046 for UF, P = 0.003 for interaction). Conclusions Applying UF improved clot firmness, and the improvement was more pronounced when pre-UF MCF-EXTEM had been reduced during CPB. |
| first_indexed | 2024-04-24T16:45:47Z |
| format | Article |
| id | doaj.art-0f0224b145ec47be86056ebd0143e9e5 |
| institution | Directory Open Access Journal |
| issn | 2005-6419 2005-7563 |
| language | English |
| last_indexed | 2024-04-24T16:45:47Z |
| publishDate | 2024-04-01 |
| publisher | Korean Society of Anesthesiologists |
| record_format | Article |
| series | Korean Journal of Anesthesiology |
| spelling | doaj.art-0f0224b145ec47be86056ebd0143e9e52024-03-29T07:56:40ZengKorean Society of AnesthesiologistsKorean Journal of Anesthesiology2005-64192005-75632024-04-0177223624510.4097/kja.236988963Effect of ultrafiltration on whole blood coagulation profile during cardiopulmonary bypass in cardiac surgery: a retrospective analysisJaemoon Lee0Dong-Kyu Lee1Won-Kyoung Kwon2Sookyung Lee3Chung-Sik Oh4Klaus Görlinger5Tae-Yop Kim6 Department of Anesthesiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea Department of Anesthesiology and Pain Medicine, Dongguk University Ilsan Hospital, Goyang, Korea Department of Anesthesiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea Department of Anesthesiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea Department of Anesthesiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, Essen, Germany Department of Anesthesiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, KoreaBackground Ultrafiltration (UF) would enhance coagulation profiles by concentrating coagulation elements during cardiopulmonary bypass (CPB) for cardiac surgery. Methods We retrospectively reviewed electronic medical records of 75 patients who had undergone cardiac surgery with rotational thromboelastometry-based coagulation management in a university hospital and analyzed the UF-induced changes in the maximum clot firmness (MCF) of extrinsically activated test with tissue factor (EXTEM) during CPB in 30 patients. Results The median volume of filtered-free water was 1,350 ml, and median hematocrit was significantly increased from 22.5% to 25.5%. As the primary measure, UF significantly increased the median MCF-EXTEM from 48.0 mm to 50.5 mm (P = 0.015, effect size r = 0.44). The area under the receiver operating characteristic curve pre-UF MCF-EXTEM for discrimination of any increase of MCF-EXTEM after applying UF was 0.89 (95% CI [0.77, 1.00], P < 0.001), and its cut-off value was 50.5 mm (specificity of 81.8% and sensitivity of 84.2% in Youden’s J statistic). In the secondary analyses using the cut-off value, UF significantly increased the median MCF-EXTEM from 40.5 mm to 42.5 mm in 18 patients with pre-UF MCF-EXTEM ≤ 50.5 mm. However, it did not increase MCF-EXTEM in 12 patients with pre-UF MCF-EXTEM > 50.5 mm. There was a significant interaction between pre-UF MCF-EXTEM values and applying UF (P < 0.001 for the subgroup, P = 0.046 for UF, P = 0.003 for interaction). Conclusions Applying UF improved clot firmness, and the improvement was more pronounced when pre-UF MCF-EXTEM had been reduced during CPB.http://ekja.org/upload/pdf/kja-23698.pdfblood coagulationcardiac surgical procedurescardiopulmonary bypassretrospective studiesthoracic surgerythrombelastographyultrafiltration |
| spellingShingle | Jaemoon Lee Dong-Kyu Lee Won-Kyoung Kwon Sookyung Lee Chung-Sik Oh Klaus Görlinger Tae-Yop Kim Effect of ultrafiltration on whole blood coagulation profile during cardiopulmonary bypass in cardiac surgery: a retrospective analysis Korean Journal of Anesthesiology blood coagulation cardiac surgical procedures cardiopulmonary bypass retrospective studies thoracic surgery thrombelastography ultrafiltration |
| title | Effect of ultrafiltration on whole blood coagulation profile during cardiopulmonary bypass in cardiac surgery: a retrospective analysis |
| title_full | Effect of ultrafiltration on whole blood coagulation profile during cardiopulmonary bypass in cardiac surgery: a retrospective analysis |
| title_fullStr | Effect of ultrafiltration on whole blood coagulation profile during cardiopulmonary bypass in cardiac surgery: a retrospective analysis |
| title_full_unstemmed | Effect of ultrafiltration on whole blood coagulation profile during cardiopulmonary bypass in cardiac surgery: a retrospective analysis |
| title_short | Effect of ultrafiltration on whole blood coagulation profile during cardiopulmonary bypass in cardiac surgery: a retrospective analysis |
| title_sort | effect of ultrafiltration on whole blood coagulation profile during cardiopulmonary bypass in cardiac surgery a retrospective analysis |
| topic | blood coagulation cardiac surgical procedures cardiopulmonary bypass retrospective studies thoracic surgery thrombelastography ultrafiltration |
| url | http://ekja.org/upload/pdf/kja-23698.pdf |
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