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Thromboelastography--does it impact blood component transfusion in pediatric heart surgery?
Lauren C Kane1, Cathy S Woodward2, Syed Adil Husain1
1Department of Cardiothoracic Surgery, University of Texas Health Sciences Center San Antonio, San Antonio, Texas.
Insights
Thromboelastography (TEG) significantly reduced platelet and cryoprecipitate transfusions in pediatric cardiac surgery. This blood management strategy proved cost-effective without increasing complications.
Area of Science:
- Pediatric Cardiac Surgery
- Transfusion Medicine
- Point-of-Care Testing
Background:
- Blood product administration is frequent in pediatric cardiac surgery.
- The cost-effectiveness of thromboelastography (TEG) for reducing transfusions requires investigation.
Purpose of the Study:
- To evaluate if thromboelastography (TEG) is a cost-effective method for reducing blood product transfusions during pediatric cardiac surgery.
Main Methods:
- A retrospective case-control study compared 50 pediatric cardiac surgery patients who underwent TEG-guided transfusions with 100 control patients.
- Patients were matched for age and risk adjustment for congenital heart surgery score.
- Blood product utilization, transfusion costs, and clinical outcomes were analyzed.
Main Results:
- TEG use led to significant reductions in platelet (1 vs. 2.2 U) and cryoprecipitate (0.7 vs. 1.7 U) transfusions.
- Hospital costs for platelet and cryoprecipitate transfusions decreased by over 50% in the TEG group.
- No significant differences were observed in mortality, length of stay, or postoperative complications.
Conclusions:
- Intraoperative use of TEG effectively reduces platelet and cryoprecipitate transfusions in pediatric cardiac surgery.
- TEG is a cost-effective tool for guiding blood product management, without compromising patient safety.
Background:
The administration of blood products during pediatric cardiac surgery is common. We sought to determine if thromboelastography (TEG) is a cost-effective tool to reduce blood product transfusion in open pediatric cardiac surgery.
Materials And Methods:
A retrospective case-control study was undertaken for 150 pediatric cardiac patients requiring cardiopulmonary bypass from January 2010-May 2012, in a University-affiliated pediatric hospital. Fifty sequential patients operated on when TEG was used were compared with 100 control patients before TEG availability. Groups were matched 2:1 for age and risk adjustment for congenital heart surgery score. Blood product utilization was compared between groups, as were outcomes metrics such as postoperative complications, length of stay, and hospital costs of transfusions.
Results:
Demographic variables, risk adjustment for congenital heart surgery score classifications, and cardiopulmonary bypass times were similar between groups. Red cell and plasma transfusion were comparable between groups. TEG patients saw a substantial reduction in the administration of platelet (1 versus 2.2 U; P < 0.0001) and cryoprecipitate (0.7 versus 1.7 U; P < 0.0001) transfusions. A greater than 50% reductions in hospital costs of platelet ($595 versus $1309) and cryoprecipitate ($39 versus $94) transfusions were observed in the TEG group. Mortality, length of stay, ventilator requirements, postoperative bleeding, and thrombotic events were equivalent.
Conclusions:
Intraoperative TEG use reduced platelet and cryoprecipitate transfusions without an increase in postoperative complications. TEG is a cost-effective method to direct blood product replacement.
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History
The history of blood transfusion dates back to the 17th century, when early attempts were made in animals. In 1818 James Blundell, a British doctor, performed the first successful human blood transfusion. Later in 1900, Karl...