Thromboelastography Associates to Decreased Plasma Transfusions in the Medical Intensive Care Unit: A Retrospective...

Bleeding patients in the medical intensive care unit (MICU) are often coagulopathic, yet the best way to guide blood product resuscitation for the critically ill is not settled. Viscoelastic tests, such as thromboelastography (TEG), are increasingly used by intensivists to guide resuscitation and restore hemostasis. We performed a retrospective study of patients admitted to the MICU at a single tertiary care center in Detroit, Michigan, USA, with a high prevalence of decompensated cirrhosis and septic shock. The historical cohort included patients prior to TEG being available in the MICU. The observational cohort included data where TEG was available and applied in our MICU to guide blood product use. Patients were included if they were an adult > 18 years of age with an initial admission to Henry Ford Hospital MICU who received any blood component therapy. A total of 927 patients met inclusion criteria with 487 (52.5%) patients in the historical cohort and 440 (47.5%) in the observational cohort. Compared with the historical cohort, patients of the observational cohort were administered significantly less plasma (658.3 mL/patient (IQR = 931) vs. 410.8 mL/patient (IQR = 381), p < 0.001). There was no significant difference in mortality (54.4% vs. 50.5%, p = 0.408) or hospital length of stay (LOS) (13 days vs. 14 days, p = 0.08). In a generalized MICU population, the introduction of TEG-guided blood component resuscitation was associated with conserved plasma without significant effect on mortality or LOS. No causation can be drawn to TEG from the retrospective nature of this study. However, this study provides impetus to further study blood product stewardship potentially derived from viscoelastic test-guided transfusions in a general MICU population.