Use of thromboelastography (TEG) or thromboelastometry (ROTEM) analysers versus usual care to monitor transfusion of blood products in surgical patients

There is a lack of knowledge from previous research to support the use of TEG or ROTEM to guide the transfusion strategy in patients with massive bleeding. Massive transfusion is defined as the total replacement of a patient's blood volume in a period of 24 hours, a transfusion of at least four red blood cell concentrates within one hour, or the replacement of 50% of the total blood volume within three hours. In the present systematic review we set out to assess the benefits and harms of TEG or ROTEM in patients at risk of major transfusion requirement. We identified nine randomized trials comparing TEG or ROTEM (776 participants) to transfusion guided by clinical judgement and standard laboratory tests, or both, in the adult cardiac surgery and liver transplantation settings. Additionally, we found two ongoing trials but we were unable to retrieve any data from them. We could not identify any beneficial effect of TEG or ROTEM on patient survival. However, we did identify positive results in our predefined outcomes such as reduced bleeding and reduced proportion of patients requiring transfusion of both platelets and fresh frozen plasma. We could not identify any harms or adverse events in patients caused by the application of TEG or ROTEM.