Skip to main content

Table 2 Effect of VHA-guided strategy on blood transfusion

From: Utility of viscoelastic hemostatic assay to guide hemostatic resuscitation in trauma patients: a systematic review

Study

Amounts of RBCs (Units)

Amounts of plasma (Units)

Amounts of platelets (Units)

Amounts of cryoprecipitate/fibrinogen (Units)

Main findings

VHA group versus

Control group

VHA group versus

Control group

VHA group versus

Control group

VHA group versus

Control group

Baksaas-Aasen [29]

6 (3–10) versus 6 (4–6)

6 (3–10) versus 7 (4–11) a*

2 (1–3) versus 1 (0–2) pools b*

4 (0–4) versus 3 (0–4) g c

Patients in the VHA group received more platelet, and less plasma at 24 h after injury, no statistically differences in the amounts of RBCs and fibrinogen equivalent were found between the two groups

Patients in the VHA group received more platelet, and fibrinogen equivalent between the baseline and hemostasis, no statistically differences in the amounts of RBCs and plasma were found between the two groups

Cochrane [20]

3.9 ± 4.0 versus 3.6 ± 3.3

2.6 ± 3.8 versus 2.5 ± 3.4 a

0.4 ± 0.8 versus 0.2 ± 0.5

0. 5 ± 1.1 versus 0.3 ± 1.0 d

No statistical differences in the number of blood components were found between the two groups, although there was a trend for more use of platelets in the post-TEG group

Campbell [21] 

5.36 ± 5.50 versus 4.57 ± 3.77

0 ± 0.97 versus 2.19 ± 3.17 ***

0.51 ± 1.11 versus 0.30 ± 0.77

0.73 ± 1.68 versus 0 ± 0 g e ***

9.17 ± 14.83 versus 1.35 ± 3.46 d***

RBCs amounts did not significantly change

There was a significant increase in cryoprecipitate and fibrinogen in the post-ROTEM group, accompanied by a reduction in the use of plasma and prothrombinex

Platelet usage was higher in the post-ROTEM group but did not reach statistical significance

Unruh [22]

6 (3–10) versus 11 (8–13) ***

4.5 (2–7.5) versus 4 (3–8.5)

1.5 (1–3) versus 2 (1–2)

1 (1–1) versus 2 (1-n/a) d

ITT analysis demonstrated a significant reduction in the amounts of RBCs transfusions, the number of patients receiving plasma and platelets in the post-TEG group

Wang [23]

4 ± 7 versus 9 ± 10 **

1 ± 5 versus 5 ± 6 **

0.4 ± 1.5 versus 2.9 ± 4.8 **

0.1 ± 0.5 versus 0.3 ± 1.2 d

Patients in the TEG group received fewer amounts of RBCs, plasma, and platelets

Mohamed [24]

4.09 versus 7.69 **

4.30 versus 6.43 *

2.28 versus 0.83 *

0.38 versus 0.47 d

Over 24 h, all patients in the post-TEG group had less RBCs and plasma, and more platelets

In the first 4 h, all patients in the post-TEG group had more plasma and platelets, and similar RBCs

Gonzalez [28]

9.5 (5–16) versus 11 (6–16)

5.0 (3–9) versus 6.0 (4–9)

1.0 (0–2) versus 1.0 (0–2)

0.0 (0–2) versus 1.0 (0–2) d*

Less cryoprecipitate was used cumulatively at 24 h in the TEG group

TEG group patients received less plasma, and platelets in the first 2 h of resuscitation

Yin [25]

5 (3–13) versus 6.5 (4–14)

5.7 (3.4–10) versus 6.1 (4–10.7)

0 (0–0) versus 0 (0–10)

0 (0–5) versus 0 (0–10) d

No statistical differences in the amounts of blood components were found between the two groups

Subgroup analysis including patients with ISS ≥ 16 showed that patients in the post-TEG group had significantly fewer consumption of RBCs, plasma, and total blood products

Tapia [26]

–

–

–

–

For patients receiving 6U or more RBCs, there was no difference in amounts of blood components between the TEG-guided group and MTP group

Blunt MOI patients who received 10U or more RBCs in the TEG-guided group received less plasma

Kashuk [27]

–

–

–

–

Although there was a trend for fewer products in the post-TEG group, there were no significant differences

  1. Data in studies of Cochrane [20], Campbell [21], and Wang [23] were expressed as mean ± standard deviation; data in studies of Mohamed [24] were expressed as mean; data in studies of Baksaas-Aasen [29], Unruh [22], Gonzalez [28], and Yin [25] were expressed as median (interquartile range). If there were data in several phases after injury, only the data in 24 h after admission/injury were recorded
  2. VHA viscoelastic hemostatic assay; TEG thrombelastography; ROTEM rotational thromboelastometry; MTP massive transfusion protocol; ISS injury severity score; RBCs red blood cells; MOI mechanism of injury; ITT: intent-to-treat
  3. ***P < 0.001 compared with VHA group, **P < 0.01 compared with VHA group, *P < 0.05 compared with VHA group
  4. afresh-frozen plasma/octaplasma
  5. bone pool = four individual platelet units
  6. cfibrinogen equivalent
  7. dcryoprecipitate
  8. efibrinogen concentrate, –: not reported