The effect of non‐point‐of‐care haemostasis management protocol implementation in cardiac surgery: A systematic review

Abstract

Objectives This systematic review aims to outline the evidence on the implementation of a non‐point‐of‐care (non‐point‐of‐care [POC]) haemostasis management protocol compared to experience‐based practice in adult cardiac surgery. Background Management of coagulopathy in cardiac surgery is complex and remains highly variable among centres and physicians. Although various guidelines recommend the implementation of a transfusion protocol, the literature on this topic has never been systematically reviewed. Methods PubMed, Embase, Cochrane Library, and Web of Science were searched from January 2000 till May 2020. Results A total of seven studies (one randomised controlled trial [RCT], one prospective cohort study, and five retrospective studies) met the inclusion criteria. Among the six non‐randomised, controlled studies, the risk of bias was determined to be serious to critical, and the one RCT was determined to have a high risk of bias. Five studies showed a significant reduction in red blood cells, fresh frozen plasma, and/or platelet transfusion after the implementation of a structural non‐POC algorithm, ranging from 2% to 28%, 2% to 19.5%, and 7% to17%, respectively. One study found that fewer patients required transfusion of any blood component in the protocol group. Another study had reported a significantly increased transfusion rate of platelet concentrate in the haemostasis algorithm group. Conclusion Owing to the high heterogeneity and a substantial risk of bias of the included studies, no conclusion can be drawn on the additive value of the implementation of a cardiac‐surgery‐specific non‐POC transfusion and haemostasis management algorithm compared to experience‐based practice. To define the exact impact of a transfusion protocol on blood product transfusion, bleeding, and adverse events, well‐designed prospective clinical trials are required.

Tactics of managing children-patients with post-coagulopathy cardiac surgery interventions

“…The risk of bleeding complications in paediatric cardiac surgery is exacerbated by complex operations in low-weight children with an undeveloped coagulation system. Early detection and characterisation of the coagulopathy using TEM/TEG will maximise the chance for early treatment of haemostatic abnormalities if bleeding occurs [24,25]. Paediatric cardiac surgery research using TEM/TEG revealed that patients with congenital heart disease have defective clot formation, especially in children with cyanotic heart disease.…”