Antje-Christin Deppe
University Hospital of Cologne, Germany
Title: Point-of-care TEG/ROTEM based coagulation management in cardiac surgery: A metaanalysis of 8,332 patients
Biography
Biography: Antje-Christin Deppe
Abstract
Objectives
Severe bleeding related to cardiac surgery is associated with increased morbidity and mortality. Thrombelastography (TEG and thrombelastometry (ROTEM are point-of-care tests (POCT). Bedside POCT provides goal-directed, individualized coagulation therapy. In this meta-analysis we aimed to determine the current evidence for or against POCT-guided algorithm with ROTEM/TEG patients with severe bleeding after cardiac surgery.
Methods
We performed a meta-analysis of randomized controlled trials (RCT) and observational trials (OT). Trials comparing transfusion strategy guided by TEG/ROTEM with a standard of care control group undergoing cardiac surgery were included. In addition at least one desiered clinical outcome had to be mentioned: mortality, re-thoracotomy rate, sternal would infection, and acute kidney injury. Also surrogate parameters such as transfusion requirements and amount of blood loss were analyzed.
Results: The literature search retrieved a total of 17 trials (9 RCT and 8 OT) involving 8,332 cardiac surgery patients. POCT guided transfusion management significantly decreased the odds for patients to receive allogeneic blood products (OR 0.63, 95%-CI 0.56 to 0.71; p<0.00001) and the re-thoracotomy rate due to postoperative bleeding (OR 0.56, 95%CI 0.45 to 0.71; p<0.00001). Furthermore, the incidence of postoperative acute kidney injury was significantly decreased in the TEG/ROTEM group (OR 0.77; 0.61 to 0.98; p=0.0278). No statistical differences were found with regard to mortality.
Conclusions: TEG/ROTEM based coagulation management decreases the risk of allogeneic blood product exposure after cardiac surgery. Furthermore, it results in significantly lower re-exploration rate, decreased incidence of pos