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TEG® 6s-Guided Algorithm for Optimizing Patient Blood Management in Cardiovascular Surgery: Systematic Literature
Courtney Maxey-Jones1, Troy G Seelhammer2, Francisco A Arabia3
1CNY Medical Services, PLLC, Baldwinsville, NY.
Insights
A new treatment algorithm using TEG 6s assays is proposed for managing bleeding during cardiac surgery. This evidence-based approach aims to guide intraoperative and postoperative transfusions effectively.
Area of Science:
- Anesthesiology and Critical Care Medicine
- Hematology
- Surgical Patient Blood Management
Background:
- Intraoperative and postoperative bleeding in cardiac surgery remains a significant clinical challenge, impacting patient outcomes.
- Existing treatment protocols for bleeding lack comprehensive guidance, particularly concerning advanced viscoelastic hemostatic assays.
- The TEG 6s device offers a rapid, point-of-care assessment of coagulation parameters.
Purpose of the Study:
- To propose a comprehensive treatment algorithm for managing bleeding in cardiac surgery patients.
- To develop a TEG 6s (thromboelastography 6s) assay-based protocol for intraoperative and postoperative transfusion guidance.
- To synthesize current evidence and expert opinion for a novel TEG 6s transfusion algorithm.
Main Methods:
- A systematic literature review was conducted to identify studies on TEG-based treatment algorithms in cardiac surgery.
- Expert opinion was solicited and integrated to refine the proposed algorithm.
- The review focused on algorithms applicable to the TEG 6s device, considering existing guidelines.
Main Results:
- Limited direct evidence exists for TEG 6s-based algorithms in cardiac surgery, with only one dedicated study identified.
- Most available algorithms were based on the older TEG 5000 device.
- A foundational TEG 6s transfusion algorithm was developed, incorporating recent patient blood management guidelines.
Conclusions:
- A novel TEG 6s-based algorithm for managing bleeding in cardiac surgery is proposed.
- This algorithm serves as a framework for future research and clinical validation.
- The proposed protocol aims to standardize and optimize transfusion strategies in cardiac surgical bleeding.
Objectives:
To propose a comprehensive TEG 6s-based intraoperative and/or immediately postoperative treatment algorithm for bleeding patients undergoing cardiac surgery. To achieve this, TEG-based treatment algorithms in cardiac surgery were evaluated through a literature review and structured expert opinion.
Design:
Systematic literature review.
Setting:
Cardiac surgery.
Participants:
Adult patients undergoing cardiac surgery with intraoperative and/or immediately postoperative bleeding.
Interventions:
TEG-guided transfusion algorithm.
Measurements And Main Results:
A literature search was conducted for original studies reporting TEG-based treatment algorithms in cardiac surgery settings. Of 304 identified manuscripts, fourteen met all inclusion criteria, with two further articles identified through authors' suggestions. There is limited evidence describing the use of TEG 6s assays in cardiac surgery with only one study reporting a dedicated algorithm using the TEG 6s device at a non-US center. Two additional studies assessed TEG 6s assays. The remaining manuscripts reported algorithms based on the TEG 5000 device. Following the author's review of the available data, and feedback from expert opinion, a simple transfusion algorithm was proposed as an initial framework for developing a TEG 6s-based protocol with consideration for the 2021 Society of Thoracic Surgery/Society of Cardiovascular Anesthesiologists/American Society of Extracorporeal Technology/Society for the Advancement of Patient Blood Management Patient Blood Management Guidelines.
Conclusions:
A new algorithm for cardiac surgery based on TEG 6s assays has been proposed based on the available evidence and expert opinion for research alignment and clinical validation.
