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J u l y 2 3 - 2 4 , 2 0 1 8 | R o m e , I t a l y
Note:
alliedacademies Joint Event on
Cardiology Congress 2018 & Microbe Infection 2018 Biomedical Research | ISSN: 0976-1683 | Volume 29
2nd World Congress on CARDIOLOGY
MICROBIOLOGY AND MICROBIAL INFECTION
&
39th Annual Congress on
Christopher F Tirotta, Biomed Res 2018, Volume 29 | DOI: 10.4066/biomedicalresearch-C1-002
ROTEM AND HUMAN FIBRINOGEN
CONCENTRATE USE IN PEDIATRIC CARDIAC
SURGERY
Christopher F Tirotta
Nicklaus Children’s Hospital, USA
Human Fibrinogen Concentrate (HFC or RiaSTAP) is a purified fibrinogen
concentrate derived from the plasma of healthy donors that undergoes
virus inactivation and removal for safety purposes. HFC is indicated for the
treatment of acute bleeding in patients with congenital fibrinogen deficiency
(CFD), including afibrinogenemia and hypofibrinogenemia. Treatment with
fibrinogen is also used for acquired fibrinogen deficiency caused by placental
abruption, massive transfusion, liver failure, disseminated intravascular
coagulation, and cardiac surgery. The ROTEM (Tem International GmbH,
Munich, Germany) is an enhanced modification of thromboelastography
(TEG), first described in 1948. Both are point-of care (POC) coagulation
monitoring instruments that test the viscoelastic properties of whole blood.
Use of the ROTEM has been shown to reduce the need and amount of
transfused blood products in pediatric cardiac surgery patients. Tirotta et al.
demonstrated that administering HFC at a dose of 70 mg/kg to neonates and
infants undergoing cardiac surgery reduced the need for fresh frozen plasma
(FFP) and cryoprecipitate. HFC can also be dosed depending on the actual
and target fibrinogen levels using the formula:
Dose (mg/kg body weight) = target level (mg/dL) − measured level (mg/dL)
1.7 (mg/dL per mg/kg body weight)
Tirotta et al also demonstrated the Maximum Clot Firmness (MCF) of the
ROTEM FIBTEM can be used as a surrogate of the fibrinogen level to dose
the HFC via the formula: predicted fibrinogen=78.61+12.38 MCF. This
formula suggests that a 1 mm of increase in MCF will correspond to a 12.38
increase in fibrinogen level. Using this formula and the POC ROTEM device,
practitioners can tailor the transfusion therapy to reduce transfusion volume
and donor exposure. CPB induced profound perturbations in ROTEM values.
The administration of platelet pheresis (25 cc/kg) while on CPB improved the
HEPTEM from 48 to 73 and the FIBTEMMCF from 4.8 mm to 8.3 mm; plasma
fibrinogen levels increased from105mg/dL to 175mg/dL. The administration
of HFC (55 mg/kg) after termination of CPB improved the FIBTEM MCF from
7.9 mm to 10.3 mm and the plasma fibrinogen level from 175 mg/dL to 240
mg/dL.
Christopher F Tirotta has been an active member of
Miami Children’s Hospital medical staff since 1991,
practicing with the Department of Anesthesiology;
he has served as the Director of Cardiac Anesthesia
since 2002. He has served as Chief of the Department
of Anesthesia since July 2017. He also has a clinical
appointment with the Department of Anesthesiology
at The University of Miami School of Medicine. He re-
ceived his BA from Cornell University in 1982 and his
MD from New York University School of Medicine in
1986. He also received an MBA degree from Colum-
bia University in 1999. He completed his internship in
Internal Medicine at SUNY at Stony Brook in 1987. He
completed his residency training in Anesthesiology at
the University of Miami/Jackson Memorial Hospital in
1990; he sub-specialized in pediatric and cardiovascu-
lar anesthesia, including heart transplantation.
BIOGRAPHY