Viscoelastic testing in major oncological surgery

Allogeneic blood transfusion may be detrimental in cancer patients. We evaluated whether ROTEM-guided algorithm to guide haemostatic resuscitation intraoperatively and in first 24 hours after surgery may affect routine haemotransfusions strategy. Prospectively we included 23 patients undergoing oncological surgery in Latvian Oncology Centre, from March till December 2020. ROTEM was performed during surgery when an active blood loss exceed 1000 ml. Patients were randomized: group treated conventionally (CG, n = 10), group using haemotransfusions algorithm guided by ROTEM (RG, n = 13). Blood products were transfused if Hb < 9g/l with haemodynamic instability in ratio 2:1 red blood cell (RBC) : fresh frozen plasma (FFP) in CG group. In contrast, in RG FFP was transfused if Clotting Time (CT)ex > 80s and cryoprecipitate (CRYO) if A10 fib < 10mm, RBC if Hb < 9 g/l.We analysed ROTEM effect on haemotransfusions strategy and, length of stay in intensive care unit. Significance p<0.05. 23 patients (mean age 61±12.6 years; 54% males) were eligible. Individual blood products FFP, RBC, platelets, CRYO as well as the total amount of haemotransfusions were compared between groups. In RG received significantly less FFP (238±277 ml vs. 317±256 ml, p = 0.03). Similar, the amount transfused of RBC was less in RG (635±500 ml vs. 879±373 ml, p = 0.07). No of patients received platelets and CRYO. The total amount of hemotransfusions was less in RG but didn’t reach statistical significance (855±691 ml vs. 1196±507 ml, p = 0.1). Median ICU length of stay was 4 ± 3 vs. 4 ± 2 days without difference. Haemotransfusions are reduced if hemotransfusions are guided by ROTEM test rather than by clinical judgement or conventional laboratory tests.