Single-Center Experience with Sonic Estimation of Elasticity via Resonance (SEER)-Guided Hemostasis in Adult Cardiac Surgical Patients.

OBJECTIVES

To evaluate a single center's experience with intraoperative sonic estimation of elasticity via resonance (SEER)-guided hemostasis management in adult cardiac surgical patients; to explore whether transfusion decisions that were concordant with predefined SEER cutoffs were associated with less bleeding and transfusion in the first 24 hours; and to explore the relationship among SEER cutoffs, intraoperative transfusion, and postoperative chest drain output.

DESIGN

A retrospective cohort study.

SETTING

A single academic medical center.

PARTICIPANTS

Patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) over a 1-year period.

INTERVENTIONS: None.

MEASUREMENTS AND MAIN

RESULTS

Patient characteristics, surgical details, and SEER measurements prior to separation from CPB were recorded. The primary study outcome was transfusion decision concordance with predefined SEER cutoffs for relevant blood products. Secondary outcomes were 24-hour chest drain output, red blood cell transfusion in the first 24 hours after surgery, and reoperation for bleeding. Overall, 260 of 448 patients (52.0%) had transfusion decisions that were fully concordant with predefined SEER cutoffs. In 448 patients, 83.9% of the platelet transfusion decisions were concordant with the platelet contribution to clot stiffness (PCS) cutoff, 76.3% of cryoprecipitate transfusion decisions were concordant with the fibrinogen contribution to clot stiffness (FCS) cutoff, and 86.6% of plasma transfusion decisions were concordant with the clotting time heparinase (CTH) cutoff. Patients who were transfused concordantly with cutoffs had lower median 24-hour chest drain output (310 mL vs 362 mL), a lower rate of RBC transfusion in the 24 hours after surgery (7.3% vs 15.4%), and fewer reoperations for bleeding (2.7% vs 6.4%) (p < 0.05 for all). Lower PCS and FCS values were associated with more intraoperative blood loss and higher 24-hour chest drain output.

CONCLUSIONS

In the majority of cases, providers made transfusion decisions that were concordant with predefined SEER cutoffs. Patients with transfusion decisions that were concordant with SEER cutoffs appeared to have less postoperative bleeding.