粘弹性止血分析(VHA)提供了凝块寿命的图形表示,并反映了凝血的实时时间。它已被用于指导创伤复苏;然而,VHAs有效性的证据仍然有限。本系统综述旨在总结已发表的证据,以评估VHA指导的创伤患者复苏策略。
PubMed,Embase,和WebofScience数据库从成立到2021年12月13日进行了搜索。本系统综述包括比较VHA引导输血与对照组复苏创伤患者的随机对照试验(RCT)或观察性研究。
在筛选的7743条记录中,十项研究,包括两项RCT和八项观察性研究,符合纳入标准。研究设计有很大的异质性,招生标准,VHA设备,VHA指导的战略,和控制策略。血栓弹力图(TEG)在8项研究中被用作输血的指导工具,和旋转血栓弹性测定法(ROTEM),在其他两项研究中使用了TEG或ROTEM。在随机对照试验中,偏倚评估的总体风险是严重或轻度的,在观察性研究中是严重或中度的。纳入研究报告的主要结果是输血(n=10),死亡率(n=10),住院时间(LOS)(n=7),重症监护病房LOS(n=7),和成本(n=4)。VHA指导策略的效果并不总是优于对照。大多数研究没有发现红细胞输血量的显著差异(n=7),等离子体(n=5),血小板(n=7),冷沉淀/纤维蛋白原(n=7),VHA引导组和对照组之间的死亡率(n=8)。值得注意的,两项随机对照试验显示,VHA指导的策略在降低死亡率方面优于或等于常规凝血试验指导的策略,分别。
尽管一些研究表明,VHA指导的策略在减少创伤患者复苏时输血需求和死亡率方面可能有益,证据仍然不够有力。由于纳入研究的数量有限,这些研究中存在巨大的异质性和严重的偏倚风险,主要降低了证据质量。强烈建议进一步研究。
Viscoelastic hemostatic assay (VHA) provides a graphical representation of a clot\'s lifespan and reflects the real time of coagulation. It has been used to guide trauma resuscitation; however, evidence of the effectiveness of VHAs is still limited. This systematic review aims to summarize the published evidence to evaluate the VHA-guided strategy in resuscitating trauma patients.
The PubMed, Embase, and Web of Science databases were searched from their inception to December 13, 2021. Randomized controlled trials (RCTs) or observational studies comparing VHA-guided transfusion to controls in resuscitating trauma patients were included in this systematic review.
Of the 7743 records screened, ten studies, including two RCTs and eight observational studies, met the inclusion criteria. There was great heterogeneity concerning study design, enrollment criterion, VHA device, VHA-guided strategy, and control strategy. Thrombelastography (TEG) was used as a guiding tool for transfusion in eight studies, and rotational thromboelastometry (ROTEM), and TEG or ROTEM were used in the other two studies. The overall risk of bias assessment was severe or mild in RCTs and was severe or moderate in observational studies. The main outcomes reported from the included studies were blood transfusion (n = 10), mortality (n = 10), hospital length of stay (LOS) (n = 7), intensive care unit LOS (n = 7), and cost (n = 4). The effect of the VHA-guided strategy was not always superior to the control. Most of the studies did not find significant differences in the transfusion amount of red blood cells (n = 7), plasma (n = 5), platelet (n = 7), cryoprecipitate/fibrinogen (n = 7), and mortality (n = 8) between the VHA-guided group and control group. Notable, two RCTs showed that the VHA-guided strategy was superior or equal to the conventional coagulation test-guided strategy in reducing mortality, respectively.
Although some studies demonstrated VHA-guided strategy probable benefit in reducing the need for blood transfusion and mortality when resuscitating trauma patients, the evidence is still not robust. The quality of evidence was primarily downgraded by the limited number of included studies and great heterogeneity and severe risk of bias in these. Further studies are strongly recommended.