Section for Transfusion Medicine, Capital Region Blood Bank, Copenhagen University Hospital, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen, Denmark.
Department of Surgery, Centre for Translational Injury Research, UT Health, University of Texas Health Science Center at Houston, Houston, TX, USA.
Scand J Trauma Resusc Emerg Med. 2017 Apr 13;25(1):39. doi: 10.1186/s13049-017-0378-9.
Management of the critically bleeding patient can be encountered in many medical and surgical settings. Common for these patients is a high risk of dying from exsanguination secondary to developing coagulopathy. The purpose of this meta-analysis was to systematically review and assess randomised controlled trials (RCTs) performed on patients in acute need for blood transfusions due to bleeding to evaluate the effect of viscoelastic haemostatic assay (VHA) guidance on bleeding, transfusion requirements and mortality.
PubMed and EMBASE were searched for RCTs that 1) randomised patients into receiving transfusions based on either a VHA-guided (thromboelastography [TEG] or rotational thromboelastometry [ROTEM]) algorithm (intervention group) or at the clinician's discretion and/or based on conventional coagulation tests (control group) and 2) adequately reported on the outcomes bleeding and/or transfusions and/or mortality. Data on bleeding, transfusions and mortality were extracted from each trial and included in a meta-analysis.
Fifteen RCTs (n = 1238 patients) were included. Nine trials referred to cardiothoracic patients, one to liver transplantation, one to surgical excision of burn wounds and one to trauma. One trial was conducted with cirrhotic patients, one with patients undergoing scoliosis surgery while one trial randomised treatment in post-partum females presenting with bleeding. The amount of transfused red blood cells (RBCs), fresh frozen plasma (FFP) and bleeding volume was found to be significantly reduced in the VHA-guided groups, whereas no significant difference was found for platelet transfusion requirements or mortality.
在许多医学和外科环境中都可能会遇到严重出血的患者。这些患者通常由于凝血功能障碍而发生大出血，有很高的死亡风险。本荟萃分析的目的是系统地回顾和评估针对因出血而急需输血的患者进行的随机对照试验（RCT），以评估基于粘弹性止血测定（VHA）的指导方案对出血、输血需求和死亡率的影响。
在 PubMed 和 EMBASE 中搜索 RCT，这些 RCT 将患者随机分配为接受输血，输血的依据是基于 VHA 指导的（血栓弹力图 [TEG] 或旋转血栓弹力测定 [ROTEM]）算法（干预组）或根据临床医生的判断和/或基于常规凝血测试（对照组），并且充分报告了出血和/或输血和/或死亡率的结果。从每个试验中提取出血、输血和死亡率的数据，并进行荟萃分析。
共纳入 15 项 RCT（n=1238 名患者）。9 项试验涉及心胸患者，1 项涉及肝移植，1 项涉及外科切除烧伤创面，1 项涉及创伤。1 项试验涉及肝硬化患者，1 项涉及接受脊柱侧凸手术的患者，1 项试验随机治疗产后出血的女性。VHA 指导组的输注红细胞（RBC）、新鲜冷冻血浆（FFP）和出血量显著减少，而血小板输注需求或死亡率无显著差异。
