Viscoelastic Blood Tests Use in Adult Cardiac Surgery: Meta-Analysis, Meta-Regression, and Trial Sequential Analysis
Viscoelastic Blood Tests Use in Adult Cardiac Surgery: Meta-Analysis, Meta-Regression, and Trial Sequential Analysis
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DOI：
10.1053/j.jvca.2019.06.030
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发表时间：
2020-01-01
影响因子：
2.8
通讯作者：
Albano, Giovanni
中科院分区：
文献类型：
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作者：
Meco, Massimo;Montisci, Andrea;Albano, Giovanni
目的：心脏手术术后出血是引起发病率和死亡率的重要原因。标准的实验室检查不能作为手术中出血的预测指标。使用粘弹性（YE）止血分析，血栓弹性成像（TEG）和旋转血栓弹性测量（ROTEM）可能是心脏手术患者的优势。本荟萃分析的目的是分析ye引导的心脏手术患者输血实践的效果（益处和危害）。设计：随机试验的荟萃分析。环境：本研究检索了PubMed、EMBASE、Scopus和Cochrane协作数据库，仅纳入随机对照试验。采用随机效应模型，按照系统评价和荟萃分析首选报告项目声明中规定的标准进行系统评价和荟萃分析。参与者：该研究包括成人心脏手术患者。干预措施：将ye -止血试验输血算法与基于临床医生判断的输血算法进行比较。测量方法和主要结果：纳入7项比较随机对照试验，共纳入1035例患者（其中522例患者使用基于TEG或rotem的输血算法）。在按照ye指导算法治疗的患者中，红细胞（优势比0.61；95%可信区间[CI]: 0.37-0.99; p: 0.04; I-2: 66%）和新鲜冷冻血浆输注（风险差0.22;95% CI: 0.11-0.33; p < 0.0001; I-2: 79%）的使用减少；血小板输注未减少（优势比0.61;95% CI: 0.32-1.15; p: 0.12; I-2 74%）。结论：本研究表明，在心脏手术患者中使用YE检测可有效减少同种异体血液制品暴露，术后12和24小时出血，以及与手术出血无关的重做手术的需要。(C) 2019 Elsevier Inc.版权所有。
Objectives: Postoperative hemorrhage in cardiac surgery is a significant cause of morbidity and mortality. Standard laboratory tests fail as predictors for bleeding in the surgical setting. The use of viscoelastic (YE) hemostatic assays thromboelastography (TEG) and rotational thromboelastometry (ROTEM) could be an advantage in patients undergoing cardiac surgery. The objective of this meta-analysis was to analyze the effects (benefits and harms) of YE-guided transfusion practice in cardiac surgery patients.Design: A meta-analysis of randomized trials.Setting: For this study, PubMed, EMBASE, Scopus, and the Cochrane Collaboration database were searched, and only randomized controlled trials were included. A systematic review and meta-analysis were performed in accordance with the standards set forth by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, using a random-effects model.Participants: The study comprised adult cardiac surgery patients.Interventions: YE-hemostatic assays transfusion algorithm compared with transfusion algorithms based on clinicians' discretion.Measurements and Main Results: Seven comparative randomized controlled trials were considered, including a total of 1,035 patients (522 patients in whom a TEG- or ROTEM-based transfusion algorithm was used). In patients treated according to YE-guided algorithms, red blood cell (odds ratio 0.61; 95% confidence interval [CI]: 0.37-0.99; p: 0.04; I-2: 66%) and fresh frozen plasma transfusions (risk difference 0.22; 95% CI: 0.11-0.33; p < 0.0001; I-2: 79%) use was reduced; platelets transfusion was not reduced (odds ratio 0.61; 95% CI: 0.32-1.15; p: 0.12; I-2 74%).Conclusions: This study demonstrated that the use of YE assays in cardiac surgical patients is effective in reducing allogenic blood products exposure, postoperative bleeding at 12 and 24 hours after surgery, and the need for redo surgery unrelated to surgical bleeding. (C) 2019 Elsevier Inc. All rights reserved.