Li Caie, Zhao Qiming, Yang Kun, Jiang Luxia, Yu Jing
Lanzhou University Second Hospital, Lanzhou 730030, China.
Department of Cardiac Surgery ICU, Lanzhou University Second Hospital, Lanzhou 730030, China.
J Thorac Dis. 2019 Apr;11(4):1170-1181. doi: 10.21037/jtd.2019.04.39.
Severe bleeding and massive transfusion of blood products may be associated with increased morbidity and mortality of cardiac surgery. A transfusion algorithm incorporating thromboelastography (TEG) or rotational thromboelastometry (ROTEM) can help to determine the appropriate time and target for the use of hemostatic blood products, which may thus reduce the quantity of blood loss as well as blood products transfused.
We conducted meta-analysis and trial sequential analysis to evaluate the effects of TEG or ROTEM-guided transfusion algorithms standard treatments for patients undergoing cardiac surgery with cardiac pulmonary bypass.
Nineteen studies with a total of 15,320 participants, including 13 randomized controlled trials (RCTs), were included. All-cause mortality was not reduced either in overall studies or in RCTs. Blood loss volume was reduced by 132 mL in overall studies [mean difference (MD): -132.46, 95% CI: -207.49, -57.43; I =53%, P<0.01], and by 103 mL in RCTs (MD: -103.50, 95% CI: -156.52, -50.48; I =0%, P<0.01). The relative risks (RRs) in RCTs were 0.89 (95% CI: 0.80-0.98; I =0%, P=0.02) for red blood cells transfusion, 0.59 (95% CI: 0.42-0.82; I =55%, P<0.01) for fresh frozen plasma transfusion, and 0.81 (95% CI: 0.74-0.90; I =0%, P<0.01) for platelet transfusion, respectively. Trial sequential analysis of continuous data on blood loss and dichotomous outcomes on transfusion of blood products suggested the benefits of a TEG/ROTEM-guided algorithm.
TEG or ROTEM-guided transfusion strategies may reduce blood loss volume and the transfusion rates in adult patients undergoing cardiac surgery.
心脏手术中严重出血和大量输注血液制品可能与发病率和死亡率增加相关。纳入血栓弹力图（TEG）或旋转血栓弹力测定法（ROTEM）的输血算法有助于确定使用止血血液制品的合适时间和目标，从而可能减少失血量以及血液制品的输注量。
我们进行了荟萃分析和试验序贯分析，以评估TEG或ROTEM引导的输血算法对接受体外循环心脏手术患者的标准治疗效果。
纳入了19项研究，共15320名参与者，其中包括13项随机对照试验（RCT）。总体研究和RCT中全因死亡率均未降低。总体研究中失血量减少了132 mL[平均差（MD）：-132.46，95%置信区间（CI）：-207.49，-57.43；I² =53%，P<0.01]，RCT中减少了103 mL（MD：-103.50，95% CI：-156.52，-50.48；I² =0%，P<0.01）。RCT中红细胞输注的相对风险（RR）为0.89（95% CI：0.80 - 0.98；I² =0%，P=0.02），新鲜冰冻血浆输注的RR为0.59（95% CI：0.42 - 0.82；I² =55%，P<0.01），血小板输注的RR为0.81（95% CI：0.74 - 0.90；I² =0%，P<0.01）。对失血量的连续数据和血液制品输注的二分结果进行试验序贯分析表明，TEG/ROTEM引导的算法有益。
TEG或ROTEM引导的输血策略可能减少接受心脏手术的成年患者的失血量和输血率。
