Diagnostic and therapeutic medical devices for safer blood management in cardiac surgery: systematic reviews, observational studies and randomised controlled trials

Abstract

This report should be referenced as follows:Murphy GJ, Mumford AD, Rogers CA, Wordsworth S, Stokes EA, Verheyden V, et al. Diagnostic and therapeutic medical devices for safer blood management in cardiac surgery: systematic reviews, observational studies and randomised controlled trials. Programme Grants Appl Res 2017;5(17). Programme Grants for Applied ResearchISSN 2050-4322 (Print) ISSN 2050-4330 (Online) This journal is a member of and subscribes to the principles of the Committee on Publication Ethics (COPE) (www.publicationethics.org/).Editorial contact: journals.library@nihr.ac.ukThe full PGfAR archive is freely available to view online at www.journalslibrary.nihr.ac.uk/pgfar. Print-on-demand copies can be purchased from the report pages of the NIHR Journals Library website: www.journalslibrary.nihr.ac.uk Criteria for inclusion in the Programme Grants for Applied Research journalReports are published in Programme Grants for Applied Research (PGfAR) if (1) they have resulted from work for the PGfAR programme, and (2) they are of a sufficiently high scientific quality as assessed by the reviewers and editors. Programme Grants for Applied Research programmeThe Programme Grants for Applied Research (PGfAR) programme, part of the National Institute for Health Research (NIHR), was set up in 2006 to produce independent research findings that will have practical application for the benefit of patients and the NHS in the relatively near future. The Programme is managed by the NIHR Central Commissioning Facility (CCF) with strategic input from the Programme Director.The programme is a national response mode funding scheme that aims to provide evidence to improve health outcomes in England through promotion of health, prevention of ill health, and optimal disease management (including safety and quality), with particular emphasis on conditions causing significant disease burden.For more information about the PGfAR programme please visit the website: http://www.nihr.ac.uk/funding/programme-grants-forapplied-research.htm This reportThe research reported in this issue of the journal was funded by PGfAR as project number RP-PG-0407-10384. The contractual start date was in July 2008. The final report began editorial review in July 2016 and was accepted for publication in April 2017. As the funder, the PGfAR programme agreed the research questions and study designs in advance with the investigators. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The PGfAR editors and production house have tried to ensure the accuracy of the authors' report and would like to thank the reviewers for their constructive comments on the final report document. However, they do not accept liability for damages or losses arising from material published in this report.This report presents independent research funded by the National Institute for Health Research (NIHR). The views and opinions expressed by authors in this publication are those of the authors and do not ...

Diagnostic accuracy of viscoelastic point-of-care identification of hypofibrinogenaemia in cardiac surgical patients: A systematic review

“…However, like the laboratory fibrinogen, both the ROTEM FIBTEM and the TEG FF provide information to assist clinicians in their decision-making on 'whether or not to administer fibrinogen'. 23 This is supported by several reviews, [28][29][30][31][32][33][34][35][36][37] including a British Society of Haematology guideline: 'VHA [viscoelastic haemostatic assays] can be used as a valid assessment of fibrinogen concentration to guide fibrinogen replacement. Grade 1B'.…”

“…39,40,61,[72][73][74][75] Moreover, most of the outcome studies have reported only a modest benefit of using viscoelastic POC devices, typically limited to a small reduction in blood loss or blood transfusion. [28][29][30][31][32][33][34][35][36][37]62,63,[76][77][78][79][80] Most reviews of viscoelastic POC tests have also commented on the low quality of evidence currently available, and have called for further studies of their accuracy and role.…”

“…23,24 These assays have become part of the routine panel of viscoelastic tests available during cardiac surgery, 27 and have been incorporated into many perioperative coagulation management algorithms. 12,[28][29][30] There have been many reviews, 12,[28][29][30][31] including systematic reviews [32][33][34][35] and health technology assessments, 36,37 on the correlation or agreement of these viscoelastic POC tests with laboratory standards in cardiac surgical patients, or on their influence on outcomes. Most have supported the use of viscoelastic POC tests in patients who are acutely bleeding, with many professional organisations and consensus guidelines recommending their use to reduce blood loss perioperatively.…”

Transfusion strategies in bleeding critically ill adults: a clinical practice guideline from the European Society of Intensive Care Medicine

“…Moreover, most studies included in the systematic review [72,73], were at unclear or high risk of bias. Two studies [75,76], assessed the resource requirements and cost-effectiveness of this technology in the cardiac surgery population suggesting small cost savings over usual care, but substantial uncertainty remains. The single RCT [74] in patients undergoing ECMO provides only very low certainty evidence for the differences between viscoelastic testing and conventional coagulation testing.…”

Blood product utilisation for coronary artery bypass graft surgery at a public and a private hospital in Western Cape Province, South Africa

“…The efficacy of cell salvage, the process whereby blood loss during surgery is minimised by reusing it, has been well documented. [31] Owing to the universal use of this procedure by both hospitals, a comparison of its effect on blood utilisation was not possible.…”