BACKGROUND: Thrombelastography (TEG) and Thrombelastometry (ROTEM) are viscoelastic whole-blood assays evaluating the haemostatic capacity of blood. These devices are used in algorithms to guide transfusion of haemostatic blood components. METHODS: The methods used for this study were systematic reviews with meta-analyses and trial sequential analyses of randomised clinical trials (RCTs) of TEG/ROTEM-based algorithm compared with standard treatment in patients with bleeding. Primary outcome was all-cause mortality. We searched the literature in seven databases (up to 31 October 2010), reference lists, registers of ongoing trials, and contacted authors and experts. We extracted data from included studies related to study methods, interventions, outcomes, bias risk and adverse events using Cochrane methodology. All trials irrespective of blinding or language status were included. RESULTS: Nine trials involving 776 participants were included. Eight trials involved cardiac surgery with an average blood loss of 390-960 ml, and one trial investigated liver transplantations. One trial was classified as low-risk-of-bias trial. We found two ongoing trials. No impact was identified on mortality, amount of blood transfused, incidence of surgical reinterventions, time to extubation, or length of stay in hospital and intensive care unit. We identified a significant reduction in blood loss favouring the use of TEG/ROTEM {85 ml [95% confidence interval (CI) 29.4-140.7]} and in the proportion of patients receiving freshly frozen plasma and platelets [relative risk 0.39 (95%CI 0.27-0.57)]. CONCLUSION: There is currently weak evidence to support the use of TEG/ROTEM as a tool to guide transfusion in patients with severe bleeding. Further studies need to address other clinical settings and with larger blood losses.
BACKGROUND: Thrombelastography (TEG) and Thrombelastometry (ROTEM) are viscoelastic whole-blood assays evaluating the haemostatic capacity of blood. These devices are used in algorithms to guide transfusion of haemostatic blood components. METHODS: The methods used for this study were systematic reviews with meta-analyses and trial sequential analyses of randomised clinical trials (RCTs) of TEG/ROTEM-based algorithm compared with standard treatment in patients with bleeding. Primary outcome was all-cause mortality. We searched the literature in seven databases (up to 31 October 2010), reference lists, registers of ongoing trials, and contacted authors and experts. We extracted data from included studies related to study methods, interventions, outcomes, bias risk and adverse events using Cochrane methodology. All trials irrespective of blinding or language status were included. RESULTS: Nine trials involving 776 participants were included. Eight trials involved cardiac surgery with an average blood loss of 390-960 ml, and one trial investigated liver transplantations. One trial was classified as low-risk-of-bias trial. We found two ongoing trials. No impact was identified on mortality, amount of blood transfused, incidence of surgical reinterventions, time to extubation, or length of stay in hospital and intensive care unit. We identified a significant reduction in blood loss favouring the use of TEG/ROTEM {85 ml [95% confidence interval (CI) 29.4-140.7]} and in the proportion of patients receiving freshly frozen plasma and platelets [relative risk 0.39 (95%CI 0.27-0.57)]. CONCLUSION: There is currently weak evidence to support the use of TEG/ROTEM as a tool to guide transfusion in patients with severe bleeding. Further studies need to address other clinical settings and with larger blood losses.
Authors: Kevin Fleming; Roberta E Redfern; Rebekah L March; Nathan Bobulski; Michael Kuehne; John T Chen; Michael Moront Journal: J Extra Corpor Technol Date: 2017-12
Authors: Peter J Lawson; Hunter B Moore; Ernest E Moore; Gregory R Stettler; Thomas J Pshak; Igal Kam; Christopher C Silliman; Trevor L Nydam Journal: J Surg Res Date: 2017-07-27 Impact factor: 2.192
Authors: Marcel Adler; Sandra Ivic; Nicolas S Bodmer; Hugo Ten Cate; Lucas M Bachmann; Walter A Wuillemin; Michael Nagler Journal: Transfus Med Hemother Date: 2017-03-08 Impact factor: 3.747
Authors: Massimo Franchini; Carlo Mengoli; Mario Cruciani; Marco Marietta; Giuseppe Marano; Stefania Vaglio; Simonetta Pupella; Eva Veropalumbo; Francesca Masiello; Giancarlo M Liumbruno Journal: Blood Transfus Date: 2018-02-26 Impact factor: 3.443