Rotational thromboelastometry–guided blood product management in major spine surgery

Naik, Bhiken I.; Pajewski, Thomas N.; Bogdonoff, David I; Zuo, Zhiyi; Clark, Patrick J.; Terkawi, Abdullah Sulieman; Durieux, Marcel E.; Shaffrey, Christopher I.; Nemergut, Edward C.

doi:10.3171/2014.12.spine14620

Cited by 85 publications

(76 citation statements)

References 22 publications

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“…Manuscript not available for reading. Contact information of corresponding author not available.Karkouti 2016 [61]Cardiac surgeryStepped-Wedge Clustered RCTLevin 2014 [62]Cardiac surgeryFocus on protamine-administrationLier 2009 [63]TraumaReviewMallaiah 2015 [64]Obstetric haemorrhageBefore-after trialManikappa 2011 [65]Cardiac surgeryWhole blood transfusionsMessenger 2011 [66]TraumaProspective cohort studyMishra 2015 [67]Cardiac surgeryFocus on platelet function testingNaik 2015 [68]Major spinal surgeryNon-randomisedPetricevic 2013 [69]Cardiac surgeryObservational trialRahe-Meyer 2009 [70]Aortic surgeryNon-randomisedRoullet 2015 [71]Orthotopic liver transplantationNon-randomisedSmart 2015 [72]Orthotopic liver transplantationRetrospective non-randomised trialStancheva 2011 [73]Orthotopic liver transplantationObservational trialTarabarin 2013 [74]Bile duct surgeryPossibly relevant. Manuscript not available for reading.…”

Section: Resultsmentioning

confidence: 99%

The use of viscoelastic haemostatic assays in goal-directing treatment with allogeneic blood products – A systematic review and meta-analysis

Fahrendorff

Oliveri

Johansson

2017

Scand J Trauma Resusc Emerg Med

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BackgroundManagement of the critically bleeding patient can be encountered in many medical and surgical settings. Common for these patients is a high risk of dying from exsanguination secondary to developing coagulopathy. The purpose of this meta-analysis was to systematically review and assess randomised controlled trials (RCTs) performed on patients in acute need for blood transfusions due to bleeding to evaluate the effect of viscoelastic haemostatic assay (VHA) guidance on bleeding, transfusion requirements and mortality.MethodsPubMed and EMBASE were searched for RCTs that 1) randomised patients into receiving transfusions based on either a VHA-guided (thromboelastography [TEG] or rotational thromboelastometry [ROTEM]) algorithm (intervention group) or at the clinician’s discretion and/or based on conventional coagulation tests (control group) and 2) adequately reported on the outcomes bleeding and/or transfusions and/or mortality. Data on bleeding, transfusions and mortality were extracted from each trial and included in a meta-analysis.ResultsFifteen RCTs (n = 1238 patients) were included. Nine trials referred to cardiothoracic patients, one to liver transplantation, one to surgical excision of burn wounds and one to trauma. One trial was conducted with cirrhotic patients, one with patients undergoing scoliosis surgery while one trial randomised treatment in post-partum females presenting with bleeding. The amount of transfused red blood cells (RBCs), fresh frozen plasma (FFP) and bleeding volume was found to be significantly reduced in the VHA-guided groups, whereas no significant difference was found for platelet transfusion requirements or mortality.

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Section: Resultsmentioning

confidence: 99%

The use of viscoelastic haemostatic assays in goal-directing treatment with allogeneic blood products – A systematic review and meta-analysis

Fahrendorff

Oliveri

Johansson

2017

Scand J Trauma Resusc Emerg Med

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“…9,36,65 In addition, a recently published application of rotational thromboelastometry-guided blood product management to major spine procedures suggests that this technology may aid in reducing blood loss, blood product use, and cost. 31 Infections accounted for 9% of all major complications, and deep wound infection was the most common infection. Multiple publications have advanced the use of intrawound vancomycin powder as a potentially effective means of reducing deep wound infections.…”

Section: Discussionmentioning

confidence: 99%

Prospective multicenter assessment of perioperative and minimum 2-year postoperative complication rates associated with adult spinal deformity surgery

Smith

Klineberg

Lafage

et al. 2016

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OBJECTIVE Although multiple reports have documented significant benefit from surgical treatment of adult spinal deformity (ASD), these procedures can have high complication rates. Previously reported complications rates associated with ASD surgery are limited by retrospective design, single-surgeon or single-center cohorts, lack of rigorous data on complications, and/or limited follow-up. Accurate definition of complications associated with ASD surgery is important and may serve as a resource for patient counseling and efforts to improve the safety of patient care. The authors conducted a study to prospectively assess the rates of complications associated with ASD surgery with a minimum 2-year follow-up based on a multicenter study design that incorporated standardized data-collection forms, on-site study coordinators, and regular auditing of data to help ensure complete and accurate reporting of complications. In addition, they report age stratification of complication rates and provide a general assessment of factors that may be associated with the occurrence of complications. METHODS As part of a prospective, multicenter ASD database, standardized forms were used to collect data on surgery-related complications. On-site coordinators and central auditing helped ensure complete capture of complication data. Inclusion criteria were age older than 18 years, ASD, and plan for operative treatment. Complications were classified as perioperative (within 6 weeks of surgery) or delayed (between 6 weeks after surgery and time of last follow-up), and as minor or major. The primary focus for analyses was on patients who reached a minimum follow-up of 2 years. RESULTS Of 346 patients who met the inclusion criteria, 291 (84%) had a minimum 2-year follow-up (mean 2.1 years); their mean age was 56.2 years. The vast majority (99%) had treatment including a posterior procedure, 25% had an anterior procedure, and 19% had a 3-column osteotomy. At least 1 revision was required in 82 patients (28.2%). A total of 270 perioperative complications (145 minor; 125 major) were reported, with 152 patients (52.2%) affected, and a total of 199 delayed complications (62 minor; 137 major) were reported, with 124 patients (42.6%) affected. Overall, 469 complications (207 minor; 262 major) were documented, with 203 patients (69.8%) affected. The most common complication categories included implant related, radiographic, neurological, operative, cardiopulmonary, and infection. Higher complication rates were associated with older age (p = 0.009), greater body mass index (p ≤ 0.031), increased comorbidities (p ≤ 0.007), previous spine fusion (p = 0.029), and 3-column osteotomies (p = 0.036). Cases in which 2-year follow-up was not achieved included 2 perioperative mortalities (pulmonary embolus and inferior vena cava injury). CONCLUSIONS This study provides an assessment of complications associated with ASD surgery based on a prospective, multicenter design and with a minimum 2-year follow-up. Although the overall complication rates were high, in interpreting these findings, it is important to recognize that not all complications are equally impactful. This study represents one of the most complete and detailed reports of perioperative and delayed complications associated with ASD surgery to date. These findings may prove useful for treatment planning, patient counseling, benchmarking of complication rates, and efforts to improve the safety and cost-effectiveness of patient care.

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“…[1,2] Ideally, real-time monitoring of hemostasis is helpful for treating coagulopathy; however, conventional hemostatic test results are available about 60 minutes after blood sampling. [3] …”

Section: Introductionmentioning

confidence: 99%

The effect of hyperglycemia on blood coagulation

Shin

Lee

et al. 2016

Medicine

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We performed a study to investigate whether contamination of hemostasis samples with a glucose-containing solution might generate spurious results in rotational thromboelastometry (ROTEM) tests.Venous blood was taken from 12 healthy volunteers and divided into 4 specimen bottles, which were contaminated with different concentrations (0%, 5%, 10%, and 20%) of glucose solution.Significant lengthening of INTEMCT was observed in the 10% and 20% groups compared with baseline values (7.7% and 9%, P = 0.041 and P = 0.037, respectively). INTEMCFT increased by 20.1% in the 20% group (P = 0.005). INTEMα-angle and INTEMMCF decreased by 3.9% and 2.7%, respectively, in the 20% group (P = 0.010 and P = 0.049, respectively). EXTEMCFT was prolonged significantly, by 10.2%, 15.5%, and 25.6%, in the 5%, 10%, and 20% groups, respectively (P = 0.004, P < 0.001, and P < 0.001, respectively). EXTEMα-angle decreased significantly by 1.9%, 3.2%, and 4.0% in the 5%, 10%, and 20% groups, respectively (P = 0.014, P = 0.001, and P = 0.005, respectively). EXTEMMCF decreased by 3.4% in the 20% group (P = 0.023). FIBTEMMCF decreased by 9.2% and 17.5% in the 10% and 20% groups, respectively (P = 0.019 and P = 0.021, respectively). A significant correlation was observed between standard glucose solution contamination in the specimens and percentage variation of EXTEMCFT, EXTEMMCF, and FIBTEMMCF.To obtain accurate data from the ROTEM test regarding the hemostatic status of patients, specimens with suspected or known contamination should not be analyzed.

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Rotational thromboelastometry–guided blood product management in major spine surgery

Cited by 85 publications

References 22 publications

The use of viscoelastic haemostatic assays in goal-directing treatment with allogeneic blood products – A systematic review and meta-analysis

The use of viscoelastic haemostatic assays in goal-directing treatment with allogeneic blood products – A systematic review and meta-analysis

Prospective multicenter assessment of perioperative and minimum 2-year postoperative complication rates associated with adult spinal deformity surgery

The effect of hyperglycemia on blood coagulation

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