评估急性出血患者对特定血液制品输血的即时需求是具有挑战性的。临床评估和常用的凝血测试不准确且耗时。本实践管理指南的目标是评估粘弹性测试的作用,包括血栓弹力图(TEG)和旋转血栓弹力图(ROTEM),在急性出血创伤的治疗中,外科,和危重病人。
对TEG/ROTEM与非TEG/ROTEM引导的血液制品输血策略进行了系统评价和荟萃分析。建议评估的分级,开发和评估方法用于评估证据水平,并为成人创伤中TEG/ROTEM引导的血液制品输血提供建议。外科,和危重病人。
使用TEG/ROTEM引导输血治疗急性出血创伤,外科,在所有人群中,危重病患者的输血倾向较少。血栓弹力图/ROTEM引导的输血与其他侵入性止血干预的数量减少相关(血管栓塞,内窥镜,或手术)在手术患者中。血栓弹力图/ROTEM引导输血与创伤患者死亡率降低相关。
在持续出血和关注凝血障碍的患者中,我们有条件地推荐使用TEG/ROTEM引导输血,与传统的凝血参数相比,指导以下三组中的每一组输血:成年创伤患者,成人手术患者,和患有危重疾病的成年患者。
系统评价/荟萃分析,三级。
Assessment of the immediate need for specific blood product transfusions in acutely bleeding patients is challenging. Clinical assessment and commonly used coagulation tests are inaccurate and time-consuming. The goal of this practice management
guideline was to evaluate the role of the viscoelasticity tests, which are thromboelastography (TEG) and rotational thromboelastometry (ROTEM), in the management of acutely bleeding trauma, surgical, and critically ill patients.
Systematic review and meta-analyses of manuscripts comparing TEG/ROTEM with non-TEG/ROTEM-guided blood products transfusions strategies were performed. The Grading of Recommendations Assessment, Development and Evaluation methodology was applied to assess the level of evidence and create recommendations for TEG/ROTEM-guided blood product transfusions in adult trauma, surgical, and critically ill patients.
Using TEG/ROTEM-guided blood transfusions in acutely bleeding trauma, surgical, and critically ill patients was associated with a tendency to fewer blood product transfusions in all populations. Thromboelastography/ROTEM-guided transfusions were associated with a reduced number of additional invasive hemostatic interventions (angioembolic, endoscopic, or surgical) in surgical patients. Thromboelastography/ROTEM-guided transfusions were associated with a reduction in mortality in trauma patients.
In patients with ongoing hemorrhage and concern for coagulopathy, we conditionally recommend using TEG/ROTEM-guided transfusions, compared with traditional coagulation parameters, to guide blood component transfusions in each of the following three groups: adult trauma patients, adult surgical patients, and adult patients with critical illness.
Systematic Review/Meta-Analysis, level III.