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
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

R16 Grade C	In adult patients undergoing cardiac surgery, the use of TEG should be considered (Grade C).

TEG, thromboelastography