PMID- 30571781
OWN - NLM
STAT- MEDLINE
DCOM- 20190527
LR  - 20200309
IS  - 1932-6203 (Electronic)
IS  - 1932-6203 (Linking)
VI  - 13
IP  - 12
DP  - 2018
TI  - Next generation viscoelasticity assays in cardiothoracic surgery: Feasibility of 
      the TEG6s system.
PG  - e0209360
LID - 10.1371/journal.pone.0209360 [doi]
LID - e0209360
AB  - BACKGROUND: Viscoelastic near-patient assays of global hemostasis have been found 
      useful and cost-effective in perioperative settings. Shortcomings of current 
      systems include substantial laboratory intensity, user-dependent reproducibility, 
      relatively large sample volumes, sensitivity to ambient vibration and limited 
      comparability between techniques and devices. The aim of this study was to assess 
      feasibility of a new, resonance-based viscoelastic whole blood methodology 
      (TEG6s) in cardiac surgery with cardiopulmonary bypass (CPB) and to compare the 
      parameters this system produces with the ROTEM delta system and standard 
      coagulation tests. METHODS: In a prospective evaluation study, twenty-three 
      consecutive cardiac surgery patients underwent hemostasis management according to 
      current guidelines, using the ROTEM delta system and standard coagulation tests. 
      Blood samples were collected prior to CPB before anesthetic induction (pre-CPB), 
      during CPB on rewarming (CPB), and 10 minutes after heparin reversal with 
      protamine (post-CPB). ROTEM and standard coagulation test results were compared 
      with TEG6s parameters, which were concurrently determined using its multi-channel 
      microfluidic cartridge system. RESULTS: TEG6s provided quantifiable results 
      pre-CPB and post-CPB, but only R (clotting time) of CKH (kaolin with heparinase) 
      was measurable during CPB (full heparinization). Spearman's correlation 
      coefficient (rs) was 0.78 for fibrinogen levels and MA CFF (functional 
      fibrinogen). Correlation of several TEG6s parameters was good (0.77 to 0.91) with 
      MCF FIBTEM, and poor (<0.56) with prothrombin time and activated partial 
      thromboplastin time (<0.44). Rs with platelet count was moderate (0.70, MA CK; 
      0.73, MA CRT). Accuracy of MA CFF for detection of fibrinogen deficiency < 1.5 
      g/L was high (ROC-AUC 0.93). CONCLUSIONS: The TEG6s system, which is based on 
      resonance viscoelastic methodology, appears to be feasible for POC hemostasis 
      assessment in cardiac surgery. Its correlations with standard coagulation 
      parameters are quite similar to those of ROTEM and there is good diagnostic 
      accuracy for fibrinogen levels lower than 1.5 g/L. During full heparinization, 
      TEG6s testing is limited to R measurement. Larger studies are needed to assess 
      superiority over other POC systems.
FAU - Erdoes, Gabor
AU  - Erdoes G
AUID- ORCID: 0000-0002-6742-1016
AD  - Department of Anesthesiology and Pain Medicine, Inselspital, Bern University 
      Hospital, University of Bern, Bern, Switzerland.
FAU - Schloer, Hannes
AU  - Schloer H
AD  - Department of Anesthesiology and Pain Medicine, Inselspital, Bern University 
      Hospital, University of Bern, Bern, Switzerland.
FAU - Eberle, Balthasar
AU  - Eberle B
AD  - Department of Anesthesiology and Pain Medicine, Inselspital, Bern University 
      Hospital, University of Bern, Bern, Switzerland.
FAU - Nagler, Michael
AU  - Nagler M
AUID- ORCID: 0000-0003-4319-2367
AD  - Department of Hematology and Central Hematology Laboratory, Inselspital, Bern 
      University Hospital, University of Bern, Bern, Switzerland.
AD  - Department of Clinical Research, University of Bern, Bern, Switzerland.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
DEP - 20181220
PL  - United States
TA  - PLoS One
JT  - PloS one
JID - 101285081
SB  - IM
MH  - Adult
MH  - Afibrinogenemia/blood/*diagnosis/etiology/prevention & control
MH  - Aged
MH  - Blood Coagulation
MH  - Blood Coagulation Tests/instrumentation/methods/standards
MH  - Cardiac Surgical Procedures/*adverse effects/methods
MH  - Cardiopulmonary Bypass/*adverse effects/methods
MH  - Feasibility Studies
MH  - Female
MH  - Humans
MH  - Intraoperative Complications/blood/*diagnosis/etiology
MH  - Male
MH  - Middle Aged
MH  - Monitoring, Intraoperative/*instrumentation/methods/standards
MH  - Practice Guidelines as Topic
MH  - Prospective Studies
MH  - Reproducibility of Results
PMC - PMC6301661
COIS- The authors have declared that no competing interests exist.
EDAT- 2018/12/21 06:00
MHDA- 2019/05/28 06:00
PMCR- 2018/12/20
CRDT- 2018/12/21 06:00
PHST- 2018/07/02 00:00 [received]
PHST- 2018/11/15 00:00 [accepted]
PHST- 2018/12/21 06:00 [entrez]
PHST- 2018/12/21 06:00 [pubmed]
PHST- 2019/05/28 06:00 [medline]
PHST- 2018/12/20 00:00 [pmc-release]
AID - PONE-D-18-19650 [pii]
AID - 10.1371/journal.pone.0209360 [doi]
PST - epublish
SO  - PLoS One. 2018 Dec 20;13(12):e0209360. doi: 10.1371/journal.pone.0209360. 
      eCollection 2018.