PB0988 - A TEG-guided treatment algorithm for major surgical bleeding

Background: Visco-elastic assays such as thromboelastography (TEG) can reduce transfusion requirements and improve mortality across of range of settings including trauma, liver transplant, and bleeding post-cardio-pulmonary bypass. The role of TEG in the diagnosis and treatment of coagulopathy in major surgical bleeding is less well defined.

Aims: To evaluate the utility of a TEG-guided algorithm in identification and treatment of coagulopathy associated with major surgical haemorrhage at a single tertiary centre.

Methods: A TEG-guided treatment algorithm was adapted from the Copenhagen protocol. The electronic records of all patients who had a TEG sample run during a three-month trial period from September to December 2021 were evaluated. Liver transplant patients were excluded. Data was collected on TEG results, blood loss, blood products administered in 24 hours pre- and post-TEG specimen, and in-hospital mortality. An unpaired T-test was performed to compare outcomes between patients adhering to the treatment algorithm vs those whose treatment deviated from the suggested protocol.

Results: During three months, 25 TEGs were performed on 22 patients. Eight patients died. The most common TEG abnormalities were prolonged R-time (5/25) and low MA (5/25), followed by low fibMA (4/25).
The treatment algorithm was adhered to in 11/22 patients. Patients whose treatment adhered to the protocol post-TEG showed a trend towards lower mean blood loss (2024 vs 2989ml, p=0.27), reduced mean RBC transfusion (1.45 vs 2.0 units, p=0.27) and reduced FFP transfusion (0.91 vs 1.83, p=0.15), however, none of the results reached statistical significance.

Conclusion(s): TEG was utilised in a high-risk group of patients who experienced significant blood loss. A normal TEG result reduced unnecessary blood product administration. When the treatment algorithm was followed there was a trend towards reduced blood loss and transfusion requirements.