Utility of viscoelastic hemostatic assay to guide hemostatic resuscitation in trauma patients: a systematic review
Abstract Objective 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 s...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-09-01
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| Series: | World Journal of Emergency Surgery |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13017-022-00454-8 |
| _version_ | 1797995487565971456 |
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| author | Zhe Zhu Yong Yu Kairui Hong Mengqin Luo Yefang Ke |
| author_facet | Zhe Zhu Yong Yu Kairui Hong Mengqin Luo Yefang Ke |
| author_sort | Zhe Zhu |
| collection | DOAJ |
| description | Abstract Objective 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. Methods 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. Results 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. Conclusion 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. |
| first_indexed | 2024-04-11T10:02:20Z |
| format | Article |
| id | doaj.art-f243a95863784b2faebe9ec5e82a9516 |
| institution | Directory Open Access Journal |
| issn | 1749-7922 |
| language | English |
| last_indexed | 2024-04-11T10:02:20Z |
| publishDate | 2022-09-01 |
| publisher | BMC |
| record_format | Article |
| series | World Journal of Emergency Surgery |
| spelling | doaj.art-f243a95863784b2faebe9ec5e82a95162022-12-22T04:30:24ZengBMCWorld Journal of Emergency Surgery1749-79222022-09-0117111310.1186/s13017-022-00454-8Utility of viscoelastic hemostatic assay to guide hemostatic resuscitation in trauma patients: a systematic reviewZhe Zhu0Yong Yu1Kairui Hong2Mengqin Luo3Yefang Ke4Department of Blood Transfusion, Hwa Mei Hospital, University of Chinese Academy of SciencesDepartment of Blood Transfusion, Hwa Mei Hospital, University of Chinese Academy of SciencesDepartment of Blood Transfusion, Hwa Mei Hospital, University of Chinese Academy of SciencesDepartment of Blood Transfusion, Hwa Mei Hospital, University of Chinese Academy of SciencesDepartment of Clinical Laboratory, Ningbo Women and Children’s HospitalAbstract Objective 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. Methods 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. Results 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. Conclusion 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.https://doi.org/10.1186/s13017-022-00454-8Viscoelastic hemostatic assayThrombelastographyRotational thromboelastometryHemostatic resuscitationBlood transfusionTrauma |
| spellingShingle | Zhe Zhu Yong Yu Kairui Hong Mengqin Luo Yefang Ke Utility of viscoelastic hemostatic assay to guide hemostatic resuscitation in trauma patients: a systematic review World Journal of Emergency Surgery Viscoelastic hemostatic assay Thrombelastography Rotational thromboelastometry Hemostatic resuscitation Blood transfusion Trauma |
| title | Utility of viscoelastic hemostatic assay to guide hemostatic resuscitation in trauma patients: a systematic review |
| title_full | Utility of viscoelastic hemostatic assay to guide hemostatic resuscitation in trauma patients: a systematic review |
| title_fullStr | Utility of viscoelastic hemostatic assay to guide hemostatic resuscitation in trauma patients: a systematic review |
| title_full_unstemmed | Utility of viscoelastic hemostatic assay to guide hemostatic resuscitation in trauma patients: a systematic review |
| title_short | Utility of viscoelastic hemostatic assay to guide hemostatic resuscitation in trauma patients: a systematic review |
| title_sort | utility of viscoelastic hemostatic assay to guide hemostatic resuscitation in trauma patients a systematic review |
| topic | Viscoelastic hemostatic assay Thrombelastography Rotational thromboelastometry Hemostatic resuscitation Blood transfusion Trauma |
| url | https://doi.org/10.1186/s13017-022-00454-8 |
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