Hemorrhage following cardiac surgery with cardiopulmonary bypass (CBP) is a major adverse event. Before the COVID-19 pandemic, an average of 288 000 cardiac surgeries were performed yearly in the United States. Despite medical advances and improved surgical techniques, CPB still poses risks to the patient. Cardiopulmonary bypass affects the clotting cascade through the loss of receptors for fibrinogen and von Willebrand factor, resulting in dilutional thrombocytopenia and decreased platelet activation. Consequently, the altered clotting cascade can lead to acute postoperative bleeding in cardiac surgery patients. For the acute care nurse practitioner (ACNP), it is essential to respond quickly and appropriately to coagulation deficits. The ACNP can use throm-boelastography (TEG) to guide blood product administration in the clinical setting. Although much of the existing literature has established the benefits of using TEG in the treatment of trauma patients, very little clinical research is available that applies to the role of the ACNP in the cardiovascular intensive care unit (CVICU). This article describes how TEG can be used to guide the ACNP in the acute postoperative management and resuscitation of the hemorrhagic cardiac surgery patient who has undergone CPB.
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