Post-CPB bleeding remains a critical challenge in neonatal cardiac surgery, and early detection of coagulopathy to guide transfusion decisions may offer significant benefits. We hypothesized that routine use of intraoperative ROTEM as a decision parameter would reduce perioperative transfusions, modulate transfusion patterns and improve the outcomes in newborns undergoing congenital heart surgery.

This retrospective cohort study was conducted at a single-center tertiary academic hospital and included 58 consecutive neonates who underwent congenital cardiac surgery with cardiopulmonary bypass between April 2022 and October 2023.

Coagulation parameters before surgery, ACT during surgery and Rotational thromboelastometry (ROTEM) for ROTEM group just before weaning from CPB were evaluated. Transfusion of platelets, fresh frozen plasma, cryopresipitate and fibrinogen concentrate were determined.

Patients with and without ROTEM-guided transfusion were compared in terms of blood product transfusion.

In this study, 58 patients (21 females, 37 males) were analyzed. Preoperatively, hemoglobin and hematocrit levels were significantly higher in the conventional group (p = 0.032, p = 0.033). Postoperatively, the Rotem group had higher hemoglobin, hematocrit, and ACT levels, while platelets were significantly lower (p = 0.0182). Fewer patients in the ROTEM group required transfusions of PRBCs, platelet concentrates, and cryoprecipitate (p < 0.05). Additionally, the Rotem group had significantly lower median intraoperative cryoprecipitate and platelet concentrates use compared to the conventional group (p < 0.001).

ROTEM analyses before discontinuation of CPB facilitate hemostasis management and reduce the use of allogenic blood products during neonatal cardiac surgery and the immediate postoperative period.