Table 3 Effect of VHA-guided strategy on mortality and other outcomes
Study | Mortality (%) | Main findings in the effect of transfusion strategy on mortality | Main findings in the effect of transfusion strategy on the other outcomes |
|---|---|---|---|
VHA group versus control group | |||
Baksaas-Aasen [29] | 11% versus 11% a 14% versus 17% b 25% versus 28% c 29% versus 31% d 25% versus 30% e | There were no statistical differences in mortality in each phase 28-day mortality was reduced in the patients who also had severe TBI in the VHA group | There were no statistically significant differences in other outcomes between the two study groups, including the proportion of patients who were alive and free of massive transfusion, rate of multiple organ dysfunction, the incidence of symptomatic thromboembolic events, 28-day ventilator-free days or ICU-free days, and hospital LOS. So did the serious adverse events More patients in the VHA group received a study intervention before hemostasis, and at 24Â h after injury The study interventions were given a median of 21Â min earlier in the VHA group |
Cochrane [Â 20] | 5% versus 13% b** 11% versus 25% c** | Mortality was significantly lower in the post-TEG group at 24 h and 30 days | Total hospital LOS was significantly greater in the post-TEG group Total cost and cost of transfusion did not reach statistically significant between the two groups Blood product wastage was significantly lower in the post-TEG group |
Campbell [21]Â | 16.9% versus 13.5% f 15.6% versus 13.5% g | There were no significant differences in mortality during hospital or ICU admission | No significant difference was seen in the ICU or hospital LOS Costs of blood products were higher in the post-ROTEM group |
Unruh [22] | 31.9% versus 55% f | A trend toward reduced mortality (P = 0.076) was observed in the post-TEG group, but it did not reach a significant difference | There was no significant study period effect on ICU admissions or ICU days, mechanical ventilation use, or hospital LOS A trend toward increased ICU days (11 vs. 7 days, P = 0.073) was observed in the post-TEG group |
Wang [23] | 3% versus 10% b 12% versus 19% f | There were no significant differences in 24-h mortality or in-hospital total mortality | Shorter hospital and ICU LOS were found in the patients of the TEG-guided group, excluded those who died within the initial 24Â h of hospital arrival |
Mohamed [24] | 34.04% versus 36.78% f | The overall mortality rate had no significant difference between the two groups However, the mortality rate was significantly lower in patients < 30 years in the post-TEG group (pre-TEG 42.5% versus post-TEG 14.29%, P = 0.0451) | Patients in the post-TEG group had a shorter hospital and ICU LOS Costs of blood products were reduced in the post-TEG group, especially in patients with penetrating injuries |
Gonzalez [28] | 7.1% versus 21.8% a* 19.6% versus 36.4% c* 8.9% versus 20% e | ITT analysis showed that the 6-h and 28-day mortality in the TEG group was significantly lower than in the CCT group There were no significant differences in hemorrhagic deaths between the two groups in the ITT analyses; however, it reached significant differences in the AT analyses | Patients in the TEG group had more ICU-free days (P = 0.091), and more ventilator-free days (P = 0.082) than those in the CCT group; however, these differences were not statistically significant The groups had similar rates of sepsis, AKI, DVT, and pulmonary embolism |
Yin [25] | 10.3% versus 6.5% c | No significant differences were found in mortality at 28-d between the two groups | No significant differences were found in ICU and hospital LOS between the two groups Costs of blood products appeared to be lower in the TEG group but were not significantly different At 24Â h, patients in the TEG group had shorter aPTT compared to patients in the control group |
Tapia [26] | – | For patients who received 6U or more RBCs, and blunt trauma patients who received 10U or more RBCs, there was no difference in mortality between the TEG-guided group and MTP group While 30-day mortality decreased in penetrating trauma patients who received 10U or more RBCs in the TEG-directed group | – |
Kashuk [27] | 29% versus 65% f | The overall mortality fell after the TEG algorithm implementation; however, it did not reach a significant difference | – |