Efficacy of thromboelastography to monitor the clinical massive transfusion in scoliosis: a randomized controlled trial
Zhonghua Wai Ke Za Zhi [Chinese Journal of Surgery]. 2016;54((2)):137-41.
OBJECTIVE To systematically assess the benefits and harms of a thromboela-stogram (TEG) guided transfusion strategy with severe bleeding. METHODS In this prospective study, 60 patients scheduled for scoliosis were included in the Fourth Affiliated Hospital, Xinjiang Medical University, from May 2014 to February 2014.Patients were allocated into either an TEG group or a standard management group. RESULTS There was no significant difference in age, weight, height and operation time between the two groups (P>0.05). There were significant differences in red blood cell concentration((4.5+/-1.5)units and(7.1+/-1.2)units)(t=4.343, P=0.001), platelet((2.5+/-1.3)units and (4.2+/-0.6)units)(t=4.554, P=0.002), fresh frozen plasma((234+/-46)ml and(514+/-41)ml)(t=3.723, P=0.004), fibrinogen((2.4+/-0.6)g and (4.6+/-0.7)g)(t=3.451, P=0.006) between the TEG group and the standard management group.The two groups in intraoperative blood loss((1 023+/-103)ml and (1 314+/-116)ml)(t=2.260, P=0.120), incidence of rebleeding after operation(3.1% and 3.6%)(chi(2)=0.340, P=0.450), hospitalization time((18+/-4)d and (16+/-6)d)(t=2.140, P=0.160) had no statistically significant differences. CONCLUSION Application of a TEG guided transfusion strategy seems to reduce the amount of bleeding during correction operation of scoliosis.
Continuous and noninvasive hemoglobin monitoring reduces red blood cell transfusion during neurosurgery: a prospective cohort study
Journal of Clinical Monitoring & Computing. 2015;29((6)):733-40.
Continuous, noninvasive hemoglobin (SpHb) monitoring provides clinicians with the trending of changes in hemoglobin, which has the potential to alter red blood cell transfusion decision making. The objective of this study was to evaluate the impact of SpHb monitoring on blood transfusions in high blood loss surgery. In this prospective cohort study, eligible patients scheduled for neurosurgery were enrolled into either a Control Group or an intervention group (SpHb Group). The Control Group received intraoperative hemoglobin monitoring by intermittent blood sampling when there was an estimated 15 % blood loss. If the laboratory value indicated a hemoglobin level of <10 g/dL, a red blood cell transfusion was started and continued until the estimated blood loss was replaced and a laboratory hemoglobin value was >l0 g/dL. In the SpHb Group patients were monitored with a Radical-7 Pulse CO-Oximeter for continuous noninvasive hemoglobin values. Transfusion was started when the SpHb value fell to l0 g/dL. Blood samples were taken pre and post transfusion. Percent of patients transfused, average amount of blood transfused in those who received transfusions and the delay time from the hemoglobin reading of <10 g/dL to the start of transfusion (transfusion delay) were compared between groups. The trending ability of SpHb, and the bias and precision of SpHb compared to the laboratory hemoglobin were calculated. Compared to the Control Group, the SpHb Group had fewer units of blood transfused (1.0 vs 1.9 units for all patients; p < 0.001, and 2.3 vs 3.9 units in patients receiving transfusions; p < 0.0 l), fewer patients receiving >3 units (32 vs 73 %; p < 0.01) and a shorter time to transfusion after the need was established (9.2 +/- 1.7 vs 50.2 +/- 7.9 min; p < 0.00 l). The absolute accuracy of SpHb was 0.0 +/- 0.8 g/dL and trend accuracy yielded a coefficient of determination of 0.93. Adding SpHb monitoring to standard of care blood management resulted in decreased blood utilization in high blood loss neurosurgery, while facilitating earlier transfusions.