Date of Award

Spring 4-28-2024

Document Type


Degree Name

Doctor of Nursing Practice (DNP)




Dr. Kacy Ballard, DNP, CRNA

First Committee Member

Dr. Chai Sribanditmongkol, PhD, RN, IBCLC, CNS

Second Committee Member

Dr. Amy Bishop, DNP, AGCNS


Cardiothoracic, Anesthesia, Rotational Thromboelastometry (ROTEM)

Subject Categories

Medicine and Health Sciences



Cardiothoracic surgical patients are at an increased risk for bleeding complications for various reasons, including induction of hypothermia, initiation of the coagulation cascade, degradation of the coagulation factors, mechanical destruction of platelets, and a systemic inflammatory response due to cardiopulmonary bypass (CPB). The American Society of Anesthesiologists recommends rotational thromboelastometry (ROTEM)-guided transfusion algorithms for perioperative blood management; however, there remains a heavy reliance on conventional coagulation laboratory values. Utilization of the following PICOT question will guide this project: In cardiothoracic surgical patients, how does the use of ROTEM versus traditional coagulation laboratory tests (PT, INR, aPTT, ACT, platelet count, and fibrinogen) affect blood product utilization, patient mortality, and overall cost peri-operatively and post-operatively? The literature review encompasses the highest level of current evidence to determine if there is a statistically significant difference in the number of blood products administered, mortality, and cost associated with utilizing ROTEM technology. The proposed project site would be a large urban hospital with an anticipated sample of 240 cardiothoracic cases over six months. Outcome data will be examined to help the project team explore and compare the impacts of a ROTEM-guided transfusion algorithm versus traditional coagulation laboratory tests. Overall, this project aims to develop a blood product management algorithm utilizing ROTEM technology to enhance the identification of coagulopathies, thereby limiting inappropriate blood product administration, lowering mortality rates, and providing a cost-effective method for coagulation management.

Keywords: cardiothoracic, anesthesia, rotational thromboelastometry (ROTEM)

Acknowledgement 1


Acknowledgement 2


Licensing Permission

Copyright, all rights reserved. Fair Use



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