Viscoelastic testing for hepatic surgery: a systematic review with meta-analysis-a protocol.
Viscoelastic tests, including thromboelastography (TEG) and rotational thromboelastometry (ROTEM), provide a global assessment of haemostatic function at the point of care. The use of a TEG or ROTEM system to guide blood product administration has been shown in some surgical settings to reduce transfusion requirements. The aim of this review is to evaluate all published evidence regarding viscoelastic testing in the setting of hepatic surgery.



We will search MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials databases to identify randomised controlled trials examining the use of viscoelastic testing for hepatic surgery. Two reviewers will independently screen titles and abstracts of studies identified and will independently extract data. Any disagreements will be resolved by discussion with a third reviewer. A meta-analysis will be conducted if feasible.



Viscoelastic devices such as TEG and ROTEM are increasingly available to clinicians as a bedside test. Patients undergoing hepatic surgery have a significant risk of blood loss and coagulopathy requiring transfusion. Theoretical benefits of use of a TEG or ROTEM system in the hepatic surgical setting include a rationalisation of blood products, a reduction in transfusion-related side effects, an improvement in patient outcomes including mortality, and a reduction in cost. This systematic review will summarise the current evidence regarding the use of viscoelastic testing for hepatic surgery.



PROSPERO CRD42016036732.
Department of Anaesthesia, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, QLD, 4006, Australia. katemccrossin@gmail.com.
Kate Elizabeth
KE
McCrossin
Department of Anaesthesia and Pain Medicine, Western Health, Gordon Street, Footscray, VIC, 3011, Australia.
David Edmund Piers
DE
Bramley
Department of Anaesthesia and Pain Medicine, Western Health, Gordon Street, Footscray, VIC, 3011, Australia.
Elizabeth
E
Hessian
Western Health Library Service, Western Health, Gordon Street, Footscray, VIC, 3011, Australia.
Evelyn
E
Hutcheon
Department of Anaesthesia and Pain Medicine, Western Health, Gordon Street, Footscray, VIC, 3011, Australia.
Georgina
G
Imberger
D001778:Blood Coagulation Disorders / Q000175:diagnosis / Q000503:physiopathology; D001803:Blood Transfusion; D006487:Hemostasis / Q000502:physiology*; D006801:Humans; D008099:Liver / Q000601:surgery*; D000067716:Point-of-Care Testing; D016032:Randomized Controlled Trials as Topic; D000078202:Systematic Reviews as Topic; D013916:Thrombelastography / Q000379:methods*; D015201:Meta-Analysis as Topic
Anaesthesia; Hepatic; ROTEM; Surgery; TEG; Viscoelastic testing