Thromboelastography-guided therapy improves patient blood management and certain clinical outcomes in elective cardiac and liver surgery and emergency resuscitation: a systematic review and analysis
Haemonetics S.A, Signy, Switzerland. Department of Health Systems Management and Policy, University of Colorado Denver, Denver, CO, USA. Haemonetics Corporation, Braintree, MA, USA. Department of Surgery, University of Colorado Denver, Denver, CO, USA.
BACKGROUND Thromboelastography (TEG((R)) 5000/6s Thrombelastograph((R)) Hemostasis Analyzer; Haemonetics((R)) , Braintree, MA) is a point-of-care system designed to monitor and analyze the entire coagulation process in real time. TEG((R)) -guided therapy has been shown to be valuable in a variety of surgical settings. OBJECTIVE While guidelines recommend viscoelastic monitoring for the management of perioperative bleeding, there are no meta-analyses specifically evaluating
the effects of TEG((R)) -guided transfusion on patient outcomes. PATIENTS/METHODS We searched MEDLINE (PubMed) and EMBASE for original articles using TEG((R)) versus control in a perioperative setting for inclusion in this systematic review. We identified nine eligible randomized controlled trials (RCTs) in two elective surgery settings (cardiac surgery and liver surgery), but only one RCT in the emergency setting. RESULTS In the elective surgery study meta-analysis, platelet (p=0.004), plasma (p<0.001) and red blood cell transfusion (p=0.14), operating room length of stay (LoS) (p=0.005), intensive care unit LoS (p=0.04) and bleeding rate (p=0.002) were reduced with TEG((R)) -guided transfusion versus control. Although blood product use was reduced, rates of mortality remained comparable between TEG((R)) and control groups. In the emergency setting evaluation, the RCT reported lower mortality in the TEG((R)) group versus the controls (p=0.049). In addition, there was a significant reduction in platelet and plasma transfusion (p=0.04 and p=0.02, respectively), and the number of ventilator-free days increased in the TEG((R)) group compared with the controls (p=0.10). CONCLUSIONS This systematic review and analysis indicate that TEG((R)) -guided hemostatic therapy can enhance blood product management and improve key patient outcomes, including LoS, bleeding rate and mortality. This article is protected by copyright. All rights reserved.
