title: Protocol based on thromboelastograph (TEG) out-performs physician preference using laboratory coagulation tests to guide blood replacement during and after cardiac surgery: a pilot study.
abstract: BACKGROUND
  Allogenic blood transfusion may affect clinical outcomes negatively. Up to 20% of blood transfusions in the United States are associated with cardiac surgery and so strategies to conserve usage are of importance. This study compares administration according to physician's choice based on laboratory coagulation tests with application of a strict protocol based on the thromboelastograph (TEG).
  
  
  METHODS
  Sixty-nine patients presenting for cardiac surgery were randomised to either study or control groups. In the study group a strict protocol was followed covering usage of all blood products according to TEG patterns. In the control group, the physician directed product administration with reference to activated partial thromboplastin time (APTT), international normalised ratio (INR), fibrinogen and platelet count. Bleeding, re-sternotomy, minimum haemoglobin, intubation time, and ICU stay were documented.
  
  
  RESULTS
  TEG-based management reduced total product usage by 58.8% in the study group but this was not statistically significant. This was associated with a statistically insignificant trend towards better short-term outcomes.
  
  
  CONCLUSIONS
  This pilot study suggests that a strict protocol for blood product replacement based on the TEG might be highly effective in reducing usage without impairing short-term outcome.
authors.affiliation: Department of Intensive Care and Hyperbaric Medicine, Alfred Hospital, Prahran, Melbourne, Victoria, Australia. awestbrook@eircom.net
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Westbrook
authors.forename: Jodi
authors.initials: J
authors.lastname: Olsen
authors.forename: Michael
authors.initials: M
authors.lastname: Bailey
authors.forename: John
authors.initials: J
authors.lastname: Bates
authors.forename: Michael
authors.initials: M
authors.lastname: Scully
authors.forename: Robert F
authors.initials: RF
authors.lastname: Salamonsen
mesh_terms: D000368:Aged; D016913:Blood Component Transfusion / Q000706:statistics & numerical data*; D006348:Cardiac Surgical Procedures; D019091:Critical Pathways; D006801:Humans; D007362:Intensive Care Units; D007430:Intraoperative Care; D007902:Length of Stay; D008875:Middle Aged; D010865:Pilot Projects; D010979:Platelet Function Tests; D019095:Point-of-Care Systems; D011182:Postoperative Care; D013916:Thrombelastography