Perioperative Hemostatic Management of Cardiohepatic Transplant with Rotational Thromboelastometry (ROTEM)
The haemostatic management of the cardiohepatic transplant becomes a challenge considering not only the coagulopathy of the end stage liver disease (ESLD) but also the alteration of the extracorporeal circulation (ECC). Standard laboratory tests (SLTs) do not allow the correct diagnosis presenting slow turnaround times and increasing the number of allogeneic transfusions. Until now, algorithms for haemostatic management of multiorgan transplants have not been published.
We propose a five step algorithm (pre ECC, intra ECC, post protamine/ basal hepatic, anhepatic and reperfusion) guided by ROTEM, based on factor concentrates therapy.