Department of Anesthesiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
Department of Anesthesiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
Transplant Proc. 2021 Sep;53(7):2312-2317. doi: 10.1016/j.transproceed.2021.07.018. Epub 2021 Aug 26.
Viscoelastic assay has been used in liver transplantation since 1985 and shown to be beneficial in detecting coagulopathy and to guide transfusion. The objective of this study was to review and evaluate the current uses of viscoelastic assay among US liver transplantation programs.
Anesthesia program directors at all 137 liver transplantation centers in the United States were contacted via email and asked to complete a 21-item survey. The primary outcome measure was the percentage of viscoelastic assay used in the perioperative management of liver transplantation. Secondary outcome measures were institutional demographics, physician training level, and device demographics.
Sixty-one of 137 (46%) centers responded. Liver transplantations were performed in the university setting at 48 of the 61 centers (77%), with a modal value of 11 to 50 liver transplantations a year and 74% in adult patients only. Most of the institutions (n = 57, 92%) had access to either rotational thromboelastometry or thrombelastography during liver transplantation. Most centers (n = 54; 87%) also used viscoelastic monitoring routinely (>60% of the time), including 42 (67.7%) that always used viscoelastic assay intraoperatively during liver transplantation. Thirty-five centers (59%) used it preoperatively, and 51 (84%) used it postoperatively. Most viscoelastic assay users (68%) learned how to use it through self-education and 10.5% learned during their fellowship or from a superuser or colleagues.
Currently, viscoelastic monitoring is widely available and routinely used in most US liver transplantation centers regardless of university or private practice setting, but training in it is limited. Only 21.1% of respondents reported that they received any type of official training in viscoelastic assay interpretation.
自 1985 年以来，黏弹性检测已应用于肝移植中，并已证明其有助于检测出凝血异常，并指导输血。本研究旨在回顾和评估美国肝移植项目中黏弹性检测的当前用途。
通过电子邮件联系美国 137 个肝移植中心的麻醉项目主任，并要求他们完成一份 21 项的调查问卷。主要的观察指标是黏弹性检测在肝移植围手术期管理中的应用百分比。次要观察指标包括机构人口统计学、医生培训水平和设备人口统计学。
在 137 个中心中，有 61 个（46%）做出了回应。61 个中心中有 48 个（77%）在大学环境中进行肝移植，每年肝移植的模式值为 11 至 50 例，且仅在成人患者中进行。大多数机构（n=57，92%）在肝移植期间都可以使用旋转血栓弹性描记术或血栓弹力图。大多数中心（n=54；87%）也常规使用黏弹性监测（>60%的时间），包括 42 个（67.7%）在肝移植期间始终使用黏弹性检测。35 个中心（59%）在术前使用，51 个中心（84%）在术后使用。大多数黏弹性检测使用者（68%）通过自我教育来学习如何使用它，10.5%的人是在他们的奖学金期间或通过超级用户或同事学习的。
目前，黏弹性监测在美国大多数肝移植中心广泛应用且常规使用，无论其机构是大学附属还是私人执业，但在这方面的培训是有限的。只有 21.1%的受访者报告说他们接受过任何类型的黏弹性检测解释的正式培训。
