Ear, Nose and Throat Disorders

Aim: Severe bleeding related to cardiac surgery is associated with increased morbidity and mortality. Thromboelastography

(TEG®) and thromboelastometry (ROTEM®) are point-of-care tests (POCT). Bedside POCT provides goal-directed, individualized

coagulation therapy. In this meta-analysis, we aimed to determine the current evidence for or against POCT-guided algorithm with

ROTEM®/TEG® in patients with severe bleeding after cardiac surgery.

Methods: We performed a meta-analysis of randomized controlled trials (RCT) and observational trials (OT). Trials comparing

transfusion strategy guided by TEG/ROTEM with a standard of care control group undergoing cardiac surgery were included. In

addition, at least one desired clinical outcome had to be mentioned such as mortality, re-thoracotomy rate, sternal infection, and

acute kidney injury. Also surrogate parameters such as transfusion requirements and amount of blood loss were analyzed.

Results: The literature search retrieved a total of 17 trials (nine RCT and eight OT) involving 8,332 cardiac surgery patients. POCT

guided transfusion management significantly decreased the odds for patients to receive allogeneic blood products (OR 0.63,

95%CI 0.56-0.71; p<0.00001) and the re-thoracotomy rate due to postoperative bleeding (OR 0.56, 95%CI 0.45-0.71; p<0.00001).

Furthermore, the incidence of postoperative acute kidney injury was significantly decreased in the TEG/ROTEM group (OR 0.77;

0.61-0.98; p=0.0278). No statistical differences were found with regard to mortality.

Conclusions: TEG/ROTEM based coagulation management decreases the risk of allogeneic blood product exposure after cardiac surgery. Furthermore, it results in significantly lower re-exploration rate, decreased incidence of postoperative acute kidney injury

and thromboembolic events in cardiac surgery patients. Results of this meta-analysis indicates that POCT guided transfusion therapy is superior to the current standard of care.