TEG® 6s-Guided Algorithm for Optimizing Patient Blood Management in Cardiovascular Surgery: Systematic Literature...

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.