Anest. intenziv. Med. 2011;22(5):253-259

The influence of temperature adjustment on thromboelastography results: prospective cohort studyAnaesthesiology - Original Paper

Čundrle Ivan jr.¹, Šrámek Vladimír¹, Pavlík Martin¹, Suk Pavel¹, Radousková Iveta¹, Zvoníček Václav^1,*

¹ Department of Anaesthesiology and Intensive Care, ICRC Brno, Medical Faculty of Masaryk University, St. Anna's University Hospital, Brno

Introduction:
Thromboelastography (TEG) and standard coagulation tests are carried out at a laboratory temperature of 37 °C, thus omitting the effects of real blood temperature. The aim of this study was comparing the results of kaolin - heparinase TEG and Rapid TEG during mild therapeutic hypothermia i.e. when the blood was analysed at the actual temperature (isothermia) and at 37°C (normothermia). The second aim was to evaluate the clinical relevance of the results and on their basis to determine the necessity to analyse TEG at the actual temperature.

Materials and Methods:
Thirty patients following CPR (cardiopulmonary resuscitation), where therapeutic hypothermia (32-34°C) was indicated for 24 hours, were included in the study. The patients were observed for 36 hours, and the TEG measurements were taken in 12-hour intervals. Standard coagulation tests, blood count, the dose of anticoagulants/antiaggregants, bleeding complications and changes in treatment according to TEG results were monitored. Data is shown as median (IQR). The Wilcoxon match pair test was used for the statistical analysis, p < 0.05 was considered significant.

Results:
In hypothermic kaolin-heparinase TEG, all parameters describing clot formation (R, K, Angle, TMA and CI) were significantly different from those measured at 37 °C (p < 0.01). Clot strength parameters (MA, G) did not differ. In Rapid TEG, the differences between hypothermia and normotermia were less pronounced. There were mostly minor signs of bleeding only and clinical judgement was not influenced by the difference in TEG measurements.

Conclusions:
Statistically significant differences in TEG results were more pronounced in kaolin-heparinase TEG than in Rapid TEG. These differences were related just to clot formation. The laboratory changes had no impact on clinical judgement.

Keywords: thromboelastography; cardiopulmonary resuscitaction

Received: June 10, 2011; Accepted: September 20, 2011; Published: October 1, 2011  Show citation