Cardiothoracic & vascular anesthesia
A single‐center, retrospective analysis to compare measurement of fibrinogen using the TEG6 analyzer to the Clauss measurement in children undergoing heart surgery
Authors' conclusion
This study demonstrates that whole blood functional fibrinogen, as estimated by TEG6s, tends to overestimate baseline plasma fibrinogen levels in pediatric age groups but aligns more accurately post-cardiopulmonary bypass, particularly in neonates and infants, suggesting its potential as a point-of-care tool in pediatric cardiac surgery.
Study context
- Population
- Pediatric patients (<18 years) undergoing cardiac surgery with CPB, August 2020 to November 2022pre-bypass paired data
- Participants
- 432 patients
- Exposure
- TEG6s functional fibrinogen vs Clauss plasma fibrinogen
- Outcome
- Agreement of TEG6s functional fibrinogen with plasma fibrinogen and prediction of post-bypass hypofibrinogenemia
- Follow-up
- Pre- and post-CPB
Methodological detailssingle-centre
- Single-centre
Main finding
As reported in the abstract
Mean difference, functional minus plasma fibrinogen (functional fibrinogen overestimated plasma fibrinogen across all age groups)
138 mg/dL
95% CI 128–149 mg/dL
Observational data: associations, not effects.
Further findings
Agreement of functional with plasma fibrinogen, post-bypass, all patient groups
- Mean difference, functional minus plasma fibrinogen (comparable)
- −6 mg/dL (95% CI: −20-8 mg/dL)
Agreement of functional with plasma fibrinogen, post-bypass (subgroup: neonates)
- Mean difference, functional minus plasma fibrinogen (functional underestimated plasma fibrinogen)
- −38 mg/dL (95% CI: −64 to −12 mg/dL)
Prediction of post-bypass hypofibrinogenemia (plasma fibrinogen ≤250 mg/dL) by functional fibrinogen, all patients
- AUC (fair accuracy)
- 0.73 (95% CI: 0.65-0.80)
Prediction of post-bypass hypofibrinogenemia (plasma fibrinogen ≤250 mg/dL) by functional fibrinogen (subgroup: infants)
- AUC (good accuracy)
- 0.80 (95% CI: 0.70-0.90)
Prediction of critical post-bypass hypofibrinogenemia (plasma fibrinogen ≤200 mg/dL)
- Similar performance
Optimal cutoffs for predicting post-bypass hypofibrinogenemia
- Functional fibrinogen level
- ≤270 mg/dL
- MAFF
- ≤15 mm
Original publication
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