Author: Noteboom SH et al.
Anesthesia & Analgesia 141(3):588–597, September 2025. doi:10.1213/ANE.0000000000007400
This study evaluated the inter- and intrarater reliability of rotational thromboelastometry (ROTEM) interpretation among an international panel of cardiovascular anesthesiologists and an intensivist. Data from 90 cardiac surgery patients were analyzed across four surgical stages, producing 343 ROTEM measurements. Interrater reliability for binary decisions was substantial to almost perfect, except after aortic declamping (Fleiss’ kappa = 0.34). Agreement on types of abnormalities and interventions was consistently strong (SMC ≥0.75). Intrarater reliability was nearly perfect (ICC ≥0.81).
Comparisons with a ROTEM-guided algorithm revealed divergence: experts tended to favor fibrinogen and protamine, while the algorithm more often suggested plasma and PCC. These discrepancies highlight the importance of clinical judgment and suggest that algorithm refinement toward personalized, data-driven approaches could enhance patient outcomes.
What You Should Know
• ROTEM interpretation by experienced anesthesiologists shows high consistency and reliability.
• Agreement was weakest immediately after aortic declamping.
• Experts and algorithms diverge on recommended interventions, particularly regarding fibrinogen/protamine versus plasma/PCC.
• Findings underscore the value of expert judgment and the need for more adaptive, individualized algorithms.
KEY POINTS
Question: How consistent are expert interpretation of rotational thromboelastometry (ROTEM) data in cardiac surgery?
Findings: The study found moderate to high interrater reliability among experts, with consistency varying across different surgical time points.
Meaning: Expert interpretation of ROTEM data is generally consistent, but the findings highlight the need for integrating more personalized approaches, potentially supported by automated clinical decision-making.
References
World Health Organization
Injuries and Violence Factsheet, 2024. https://www.who.int/news-room/fact-sheets/detail/injuries-and-violence
American Society of Anesthesiologists
Statement on Principles: Trauma Anesthesiology. https://www.asahq.org/standards-and-practice-parameters/statement-on-principles-trauma-anesthesiology
Thank you to Anesthesia & Analgesia for making this work available.