Skip to main content

Advertisement

SpringerLink
Log in

Diagnostic Agreement Between TEG5000 and TEG6S in the Assessment of Hemostasis in Pediatric Cardiac Surgery: A Prospective Non-inferiority Study

  • Research
  • Published:
Pediatric Cardiology Aims and scope Submit manuscript

Abstract

Thromboelastography (TEG) is a point-of-care test (POCT) used to analyze the hemostatic properties of whole blood. TEG® 5000and TEG® 6s (Haemonetics Corp, USA) measure the same parameters describing clot viscoelasticity using different methodologies. The purpose of this study was to evaluate agreement between TEG5000 and TEG6s measurements. We analyzed prospectively collected tests resulting from paired blood samples in cardiac surgery pediatric patients at one hour (T0) and 24 h (T1) postoperatively. Each citrated sample was utilized for TEG® 5000 and TEG ®6s. Six specific TEG parameters were analyzed and compared: R kaolin time (RK), R kaolin heparinase (RKH) time, K kaolin time (KK), K kaolin heparinase time KH (KKH), Maximum Amplitude kaolin (MAK), Maximal Amplitude Kaolin Heparinase (MAKH). We enrolled 30 patients. Median (interquartile range) patients’ age was 206 (20–597) days. All surgical patients underwent correction except 5 who were palliated. At T0, RK and RKH showed an average (standard deviation) % bias of 15.8 (31) and 16.1 (28), respectively, with similar results at T1. A % bias of -6 (23) and − 6 [15] in MAK was found at T0 and T1, respectively. Similarly, MAKH % bias was 1.5 (22) and 7.6 (29) at T0 and T1, respectively. At both timepoints, low % biases (< ± 6%) were demonstrated in KK and KKH. All parameters showed improved coagulation from T0 to T1, but without significant interaction between type of device and time. Analysis of the entire pool of 60 paired samples showed no agreement in diagnostic performance (within the range vs. outside the range) in 12 (20%), 5 (9.8%), 1 (1.7%), 4 (7.8%), 9 (15%), and 5 (9.8%) cases for RK, RKH, MAK, MAKH, KK and KKH, respectively. We observed substantial agreement in MAK and KK in a cohort of pediatric patients undergoing uncomplicated cardiac surgery. Our findings suggest that TEG®5000 and TEG®6s are interchangeable for assessing these parameters.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Williams GD, Bratton SL, Nielsen NJ, Ramamoorthy C (1998) Fibrinolysis in pediatric patients undergoing cardiopulmonary bypass. J Cardiothorac Vasc Anesth 12(6):633–638. https://doi.org/10.1016/s1053-0770(98)90233-6

    Article  CAS  PubMed  Google Scholar 

  2. Ignjatovic V, Than J, Summerhayes R, Newall F, Horton S, Cochrane A, Monagle P (2011) Hemostatic response in paediatric patients undergoing cardiopulmonary bypass surgery. Pediatr Cardiol 32(5):621–627. https://doi.org/10.1007/s00246-011-9929-4

    Article  PubMed  Google Scholar 

  3. Ravn HB, Andreasen JB, Hvas AM (2017) Does whole blood coagulation analysis reflect developmental haemostasis? Blood Coagul Fibrinolysis 28(3):218–223. https://doi.org/10.1097/MBC.0000000000000585

    Article  PubMed  Google Scholar 

  4. Chan KL, Summerhayes RG, Ignjatovic V, Horton SB, Monagle PT (2007) Reference values for kaolin-activated thromboelastography in healthy children. Anesth Analg 105(6):1610–1613. https://doi.org/10.1213/01.ane.0000287645.26763.be

    Article  PubMed  Google Scholar 

  5. Kettner SC, Pollak A, Zimpfer M, Seybold T, Prusa AR, Herkner K, Kuhle S (2004) Heparinase-modified thrombelastography in term and preterm neonates. Anesth Analg 98(6):1650–1652. https://doi.org/10.1213/01.ANE.0000115149.25496.DD

    Article  CAS  PubMed  Google Scholar 

  6. Perez-Ferrer A, Vicente-Sanchez J, Carceles-Baron MD, Van der Linden P, Faraoni D (2015) Early thromboelastometry variables predict maximum clot firmness in children undergoing cardiac and non- cardiac surgery. Br J Anaesth 115(6):896–902. https://doi.org/10.1093/bja/aev369.PMID

    Article  CAS  PubMed  Google Scholar 

  7. Faraoni D, Meier J, New HV, Van der Linden PJ, Hunt BJ (2019) Patient blood management for neonates and children undergoing cardiac surgery: 2019 NATA Guidelines. J Cardiothorac Vasc Anesth 33(12):3249–3263. https://doi.org/10.1053/j.jvca.2019.03.036

    Article  PubMed  Google Scholar 

  8. Rizza A, Ricci Z, Pezzella C, Favia I, Di Felice G, Ranucci M, Cogo P (2017) Kaolin- activated thromboelastography and standard coagulation assays in cyanotic and acyanotic infants undergoing complex cardiac surgery: a prospective cohort study. Paediatr Anaesth 27(2):170–180. https://doi.org/10.1111/pan.13038

    Article  PubMed  Google Scholar 

  9. Emani S, Emani VS, Diallo FB, Dutta P, Matte GS, Nathan M, Ibla JC, Emani SM (2022) Comparison of Thromboelastography Devices TEG®6S Point of Care device vs. TEG®5000 in Pediatric Patients undergoing cardiac surgery. J Extra Corpor Technol 54:42–49. https://doi.org/10.1182/ject-42-49

    Article  PubMed  PubMed Central  Google Scholar 

  10. Gurbel PA, Bliden KP, Tantry US, Monroe AL, Muresan AA, Brunner NE, Lopez-Espina CG, Delmenico PR, Cohen E, Raviv G, Haugen DL, Ereth MH (2016) First report of the point-of-care TEG: a technical validation study of the TEG-6S system. Platelets 27(7):642–649. https://doi.org/10.3109/09537104.2016.1153617

    Article  CAS  PubMed  Google Scholar 

  11. Wong Q, Byrne KP, Robinson SC (2020) Clinical agreement and interchangeability of TEG5000 and TEG6s during cardiac surgery. Anaesth Intensive Care 48(1):43–52. https://doi.org/10.1177/0310057X19897657

    Article  PubMed  Google Scholar 

  12. Robson JL, Dj Watts A, McCulloch TJ, Paleologos MS, Mortimer RA, Ca Kam P (2019) Correlation and agreement between the TEG® 5000 and the TEG® 6s during liver transplant surgery. Anaesth Intensive Care 47(1):32–39. https://doi.org/10.1177/0310057X18811731

    Article  PubMed  Google Scholar 

  13. Lloyd-Donald P, Churilov L, Zia F, Bellomo R, Hart G, McCall P, Mårtensson J, Glassford N, Weinberg L (2019) Assessment of agreement and interchangeability between the TEG5000 and TEG6S thromboelastography haemostasis analysers: a prospective validation study. BMC Anesthesiol 30(1):45. https://doi.org/10.1186/s12871-019-0717-7

    Article  Google Scholar 

  14. Wegner J, Popovsky MA (2010) Clinical utility of thromboelastography: one size does not fit all. Semin Thromb Hemost 36(07):699–706. https://doi.org/10.1055/s-0030-1265286

    Article  PubMed  Google Scholar 

  15. Moynihan KM, Johnson K, Rane M, Norman A, Humphreys S, Stocker C, Gibbons K, Roy J (2021) Pediatric Thromboelastograph 6s and Laboratory Coagulation reference values. Arch Pathol Lab Med 145(11):1413–1423. https://doi.org/10.5858/arpa.2020-0647-OA

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

No financial support was required for this study.

Author information

Authors and Affiliations

  1. Pediatric Cardiac Intensive Care Unit, Department of Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital, IRCCS, Piazza S.Onofrio 4, Rome, 00165, Italy

    Simona Benegni, Chiara Giorni, Valeria Raggi, Cristiana Garisto, Francesca Giovanna Iodice, Alessandra Rizza, Eleonora Marinari, Isabella Favia & Luca Di Chiara

  2. Clinical Epidemiology, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy

    Simone Piga & Maria Luisa Ciofi Degli Atti

  3. Department of Anesthesia and Critical Care, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy

    Chiara Buonomo

  4. Pediatric Intensive Care Unit, Meyer Children’s University Hospital, IRCCS, Florence, Italy

    Zaccaria Ricci

  5. Department of Health Sciences, Section of Anesthesiology and Intensive Care, University of Florence, Florence, Italy

    Zaccaria Ricci

Authors
  1. Simona Benegni
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chiara Giorni
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Valeria Raggi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Cristiana Garisto
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Francesca Giovanna Iodice
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Alessandra Rizza
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Eleonora Marinari
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Isabella Favia
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Simone Piga
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Chiara Buonomo
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Luca Di Chiara
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Maria Luisa Ciofi Degli Atti
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Zaccaria Ricci
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors wrote the manuscript and reviewed all text and figures. All authors approved the final manuscript.

Corresponding author

Correspondence to Simona Benegni.

Ethics declarations

Competing interests

The authors declare no competing interests.

Conflict of interest

The authors have no potential conflicts of interest to disclose.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Benegni, S., Giorni, C., Raggi, V. et al. Diagnostic Agreement Between TEG5000 and TEG6S in the Assessment of Hemostasis in Pediatric Cardiac Surgery: A Prospective Non-inferiority Study. Pediatr Cardiol (2023). https://doi.org/10.1007/s00246-023-03311-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00246-023-03311-w

Keywords

Search

Navigation