K. Baksaas‑Aasen, LS Gall, J Stensballe et al.
Intensive Care Med (2021) 47:49–59
Aim of Study
To investigate the impact of TEG-guided resuscitation protocol on outcomes in traumatic haemorrhage
Design & Location
Randomised controlled trial, multi-centre (international)
Methodology
Patients with traumatic haemorrhage requiring empirical initiation of major haemorrhage protocol.
Randomised to blood product management guided by either TEG or conventional coagulation studies.
Primary Outcome
Survival free of massive transfusion (≥10 RBCs) @ 24h
Secondary Outcomes
Survival @ 6h, 24h, 28/7, 90/7 Total products Ventilator-free & ICU-free days at 28/7 LoS ICU/hospital % with thromboembotic events, MOF, any adverse event
Statistics
Logistic regression
Intention to treat analysis
Results
No significant difference in primary outcome between groups
67% vs 64% – OR 1.15 (0.76-1.73)
No significant differences in any secondary outcome
Conclusion/Discussion
Unexpectedly low rates of coagulopathy – accounting for negative result?
No difference in management/blood product use between groups as a result of different investigations – so perhaps unsuprising no difference in outcomes
Stated Limitations from Study
Population was trauma haemorrhage, cf obstetric/medical
Study in MTCs already used to delivering balanced transfusion – potential for greater impact in non-trauma centres?
Discussion from Journal Club Meeting (? Change of practice)
Usefulness of TEG context-dependent e.g. time to availability of blood products. At Kingston hospital, a key factor is the potential usefulness of TEG as additional evidence to facilitate release/authorisation of blood products by our Haematology colleagues.
Summary by Dr P Vila de Mucha. Journal Club Meeting on 23 January 2023
Image from FOAMCast https://foamcast.org/2019/07/31/thromboelastography-teg-guided-resuscitation/
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