3.6 Effect of perioperative strategies that minimise blood loss
3.6.8 Point-of-care testing
The detailed findings of the systematic review for this intervention can be found in Section 3.7.1 of Volume 1b of the technical report.4 A preliminary literature search found limited evidence for the effect of point-of-care testing other than thromboelastography (TEG). The CRG decided to limit the scope of this intervention to comparative studies of TEG and TEG-based point-of-care tests, which are predominantly used intraoperatively. Five Level II studies and two Level III studies were identified, of poor to fair quality.205–210
Transfusion requirements
A meta-analysis found that the use of a TEG-based transfusion algorithm resulted in a significant reduction in the incidence of transfusion with fresh frozen plasma (FFP) and platelets, and may have reduced the incidence of RBC transfusion, compared with the use of a transfusion protocol that was not TEG based.
EVIDENCE STATEMENTS – point-of-care testing | Evidence | Consistency | Clinical impact | Generalisability | Applicability |
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In adult patients undergoing cardiac surgery, the use of thromboelastography may reduce the incidence of FFP transfusion. | |||||
In adult patients undergoing cardiac surgery, the effect of the use of thromboelastography on the incidence of RBC transfusion is uncertain. | X | ||||
In adult patients undergoing cardiac surgery, the use of thromboelastography may reduce the incidence of platelet transfusion. | |||||
In adult patients undergoing cardiac surgery, the use of thromboelastography may reduce the volume of FFP transfused. | |||||
In adult patients undergoing cardiac surgery, the effect of the use of thromboelastography on volume of RBC transfusion is uncertain. | X | ||||
In adult patients undergoing cardiac surgery, the effect of the use of thromboelastography on volume of platelet transfusion is uncertain. | |||||
In adult patients undergoing cardiac surgery, the use of thromboelastography does not appear to have an effect on blood loss. | X | ||||
In adult patients undergoing cardiac surgery, the effect of the use of thromboelastography on mortality is uncertain. | X | ||||
In adult patients undergoing cardiac surgery, the effect of the use of thromboelastography on morbidity is uncertain. | NA | X | |||
In adult patients undergoing surgery in which substantial blood loss is anticipated, the effect of the use of thromboelastography on quality of life is unknown. | NA | NA | NA | NA | NA |
In adult patients undergoing cardiac surgery, the effect of the use of thromboelastography on haemoglobin concentration is uncertain. | X | ||||
In adult patients undergoing cardiac surgery, the effect of the use of thromboelastography on the risk of reoperation for bleeding is uncertain. | X | ||||
In adult patients undergoing cardiac surgery, the effect of the use of thromboelastography on coagulation status is uncertain. | NA | X | |||
In adult patients undergoing cardiac surgery, the effect of the use of thromboelastography on length of hospital stay is uncertain. | NA | X | |||
In adult patients undergoing cardiac surgery, the effect of the use of thromboelastography on length of ICU stay is uncertain. | NA | X |
FFP, fresh frozen plasma; ICU, intensive care unit; RBC, red blood cell
(See Table 2.2)
RECOMMENDATION – point-of-care testing
R16Grade C |
In adult patients undergoing cardiac surgery, the use of TEG should be considered (Grade C). |
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TEG, thromboelastography