Perspectives and Evolution of Intraoperative Transfusion Goal Directed Protocols with Viscoelastic Methods and Perioperative Outcomes in Children
Research in Pediatrics & Neonatology
A recent systematic review and meta-analysis was realized to determine the impact of intraoperative transfusion goal directed protocols with viscoelastic methods on postoperative outcome in children. This study is part of a vast and extended Thesis Project concerning the impact of Goal Directed therapies on postoperative outcome in the pediatric population. Objective of this Editorial: To analyze the results, conclusions and future perspective of this recent systematic review and meta-analysis
... n the impact of intraoperative transfusion goal directed protocols with viscoelastic methods on perioperative outcome in children. Result and conclusion: This systematic review and meta-analysis of 9 randomized and non-randomized controlled trials in 1365 children in trauma, cardiac, craniosynostosis and liver transplantation demonstrated that mortality, morbidity (organ dysfunction), Packed Red Blood Cells (PRBC) and platelet transfusion were not different between the two groups. However, the trial revealed that the number of patients transfused with fresh frozen plasma (FFP) and Length of Hospital Stay (LOS) were lower in the group (experimental group) where blood product administration was guided with thromboelastography (TEG) or rotational thromboelastometry (ROTEM). It was also evidenced that the number of patients who received intraoperatively cryoprecipitate or fibrinogen was higher in the experimental group. These results are not surprising. Mortality and morbidity in these patients included in this study were explained by other factors than transfusion. However, FFP administration and LOS were reduced. This is not surprising either because the device helps to detect coagulation disorders which can be corrected rapidly once diagnosed. The reduction in LOS in this setting was explained by the reduction in FFP administration since the latter has been shown in other studies to increase LOS and other adverse outcomes. The results of this study encourage the use of TEG/ROTEM to guide blood product administration to reduce FFP transfusion and LOS related to the latter.