{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T01:02:37Z","timestamp":1771549357353,"version":"3.50.1"},"reference-count":21,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2023,12,10]],"date-time":"2023-12-10T00:00:00Z","timestamp":1702166400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Anesthesia"],"published-print":{"date-parts":[[2024,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Newer generation viscoelastic tests, TEG6s, offer point\u2010of\u2010care hemostatic therapy in adult patients. However, their efficacy in estimating fibrinogen levels in pediatric patients undergoing cardiac surgery is not well established.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aims<\/jats:title><jats:p>This study evaluates TEG6s for estimating fibrinogen levels in pediatric cardiac surgery patients and its predictive capability for post\u2010bypass hypofibrinogenemia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A single\u2010center, retrospective study on pediatric patients (under 18\u2009years) who underwent cardiac surgery with cardiopulmonary bypass from August 2020 and November 2022. Blood samples for estimated whole blood functional fibrinogen level via TEG6s (Haemonetics Inc.) and concurrent laboratory\u2010measured plasma fibrinogen via von Clauss assay were collected at pre\u2010 and post\u2010cardiopulmonary bypass.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Paired data for TEG6s estimated functional fibrinogen levels and plasma fibrinogen were analyzed for 432 pediatric patients pre\u2010bypass. It was observed that functional fibrinogen consistently overestimated plasma fibrinogen across all age groups with a mean difference of 138\u2009mg\/dL (95% confidence interval [CI]: 128\u2013149\u2009mg\/dL). This positive bias in the pre\u2010bypass data was confirmed by Bland\u2013Altman analysis. Post\u2010bypass, functional fibrinogen estimates were comparable to plasma fibrinogen in all patient groups with a mean difference of \u22126\u2009mg\/dL (95% CI: \u221220\u20138\u2009mg\/dL) except for neonates, where functional fibrinogen levels underestimated plasma fibrinogen with a mean difference of \u221238\u2009mg\/dL (95% CI: \u221264 to \u221212\u2009mg\/dL). The predictive accuracy of functional fibrinogen for detecting post\u2010bypass hypofibrinogenemia (plasma fibrinogen \u2264250\u2009mg\/dL) demonstrated overall fair accuracy in all patients, indicated by an area under the curve of 0.73 (95% CI: 0.65\u20130.80) and good accuracy among infants, with an area under the curve of 0.80 (95% CI: 0.70\u20130.90). Similar performance was observed in predicting critical post\u2010bypass hypofibrinogenemia (plasma fibrinogen \u2264200\u2009mg\/dL). Based on these analyses, optimal cutoffs for predicting post\u2010bypass hypofibrinogenemia were established as a functional fibrinogen level \u2264270\u2009mg\/dL and MA<jats:sub>FF<\/jats:sub> \u226415\u2009mm.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>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\u2010cardiopulmonary bypass, particularly in neonates and infants, suggesting its potential as a point\u2010of\u2010care tool in pediatric cardiac surgery. However, the variability in TEG6s performance before and after bypass highlights the need for careful interpretation of its results in clinical decision\u2010making. Despite its contributions to understanding TEG6s in pediatric cardiac surgery, the study's design and inherent biases warrant cautious application of these findings in clinical settings.<\/jats:p><\/jats:sec>","DOI":"10.1111\/pan.14820","type":"journal-article","created":{"date-parts":[[2023,12,10]],"date-time":"2023-12-10T15:25:36Z","timestamp":1702221936000},"page":"619-627","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["A single\u2010center, retrospective analysis to compare measurement of fibrinogen using the TEG6 analyzer to the Clauss measurement in children undergoing heart surgery"],"prefix":"10.1111","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2491-6705","authenticated-orcid":false,"given":"Nischal","family":"Gautam","sequence":"first","affiliation":[{"name":"Department of Anesthesiology McGovern Medical School, UT Health Houston  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vy","family":"Tran","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology McGovern Medical School, UT Health Houston  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Evelyn","family":"Griffin","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology McGovern Medical School, UT Health Houston  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jehan","family":"Elliott","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology McGovern Medical School, UT Health Houston  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eric","family":"Rydalch","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology McGovern Medical School, UT Health Houston  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kelbie","family":"Kerr","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology McGovern Medical School, UT Health Houston  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alex J.","family":"Wilkinson","sequence":"additional","affiliation":[{"name":"McGovern Medical School, UT Health Houston  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xu","family":"Zhang","sequence":"additional","affiliation":[{"name":"Division of Clinical and Translational Sciences, Department of Internal Medicine, McGovern Medical School The University of Texas Health Science Center at Houston  Houston Texas USA"},{"name":"Biostatistics\/Epidemiology\/Research Design (BERD) component, Center for Clinical and Translational Sciences (CCTS) The University of Texas Health Science Center at Houston  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7704-3728","authenticated-orcid":false,"given":"Sepideh","family":"Saroukhani","sequence":"additional","affiliation":[{"name":"Division of Clinical and Translational Sciences, Department of Internal Medicine, McGovern Medical School The University of Texas Health Science Center at Houston  Houston Texas USA"},{"name":"Biostatistics\/Epidemiology\/Research Design (BERD) component, Center for Clinical and Translational Sciences (CCTS) The University of Texas Health Science Center at Houston  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,12,10]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0209360"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.23599"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.jvca.2019.04.003"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000002856"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000002859"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.3109\/09537104.2016.1153617"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-020-63964-y"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12871-019-0717-7"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm12020477"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/aas.14144"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0000000000001058"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1460-9592.2010.03410.x"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000000531"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000539-200006000-00011"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000000172"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/pan.13048"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1177\/2150135119888155"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000539-199508000-00026"},{"issue":"2","key":"e_1_2_12_20_1","first-page":"241","article-title":"Practice guidelines for perioperative blood management: an updated report by the American Society of Anesthesiologists Task Force on perioperative blood management*","volume":"122","author":"Management AS of ATF on PB","year":"2014","journal-title":"Anesthesiology"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.jvca.2022.03.042"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.jvca.2019.03.036"}],"container-title":["Pediatric Anesthesia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/pan.14820","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,1,2]],"date-time":"2025-01-02T10:49:08Z","timestamp":1735814948000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/pan.14820"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12,10]]},"references-count":21,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2024,7]]}},"alternative-id":["10.1111\/pan.14820"],"URL":"https:\/\/doi.org\/10.1111\/pan.14820","archive":["Portico"],"relation":{},"ISSN":["1155-5645","1460-9592"],"issn-type":[{"value":"1155-5645","type":"print"},{"value":"1460-9592","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,12,10]]},"assertion":[{"value":"2022-09-28","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-11-28","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-12-10","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}