From the Department of Anesthesia and Intensive Care, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom.
Great Ormond Street Hospital NHS Foundation Trust, Cardiac Intensive Care Unit, London, United Kingdom.
Anesth Analg. 2020 Jun;130(6):1594-1604. doi: 10.1213/ANE.0000000000004563.
Bleeding and coagulation management are essential aspects in the management of neonates and children undergoing cardiac surgery. The use of point-of-care tests (POCTs) in a pediatric setting is not as widely used as in the adult setting. This systematic review aims to summarize the evidence showed by the literature regarding the use of POCTs in children undergoing cardiac surgery. We included all studies examining the pediatric population (<18 years old) undergoing cardiac surgery in which the coagulation profile was assessed with POCTs. Three electronic databases (PubMed, Embase, and the Cochrane Controlled Clinical Trials register) were searched. Tests involved were heparin effect tests, viscoelastic tests, and platelet function tests. Due to the wide heterogeneity of the patients and tests studied, a formal meta-analysis was impossible, and the results are therefore presented through a systematic review. Eighty articles were found, of which 47 are presented in this review. At present, literature data are too weak to define POCTs as a "gold standard" for the treatment of perioperative bleeding in pediatric cardiac surgery. Nevertheless, introduction of POCTs into postoperative algorithms has shown to improve bleeding management, patient outcome, and cost efficiency.
出血和凝血管理是进行心脏手术的新生儿和儿童管理中的重要方面。在儿科环境中，即时检验（POCT）的使用不如在成人环境中广泛。本系统评价旨在总结文献中关于在接受心脏手术的儿童中使用 POCT 的证据。我们纳入了所有研究儿科人群（<18 岁）接受心脏手术的研究，其中使用 POCT 评估凝血谱。我们检索了三个电子数据库（PubMed、Embase 和 Cochrane 对照临床试验登记处）。涉及的检测包括肝素效应检测、粘弹性检测和血小板功能检测。由于研究的患者和检测存在广泛的异质性，因此无法进行正式的荟萃分析，因此结果通过系统评价呈现。共发现 80 篇文章，其中 47 篇在本综述中呈现。目前，文献数据还不够强大，无法将 POCT 定义为儿科心脏手术围手术期出血治疗的“金标准”。然而，将 POCT 引入术后算法已被证明可以改善出血管理、患者预后和成本效益。
