• Massimo Meco, Andrea Montisci, Enrico Giustiniano, Massimiliano Greco, Federico Pappalardo, Liborio Mammana, Paolo Panisi, Claudio Roscitano, Silvia Cirri, Francesco Donatelli, and Giovanni Albano.
• Anesthesia and Intensive Care Department, Humanitas Gavazzeni Clinic, Bergamo, Italy.
• J. Cardiothorac. Vasc. Anesth. 2020 Jan 1; 34 (1): 119-127.

ObjectivesPostoperative hemorrhage in cardiac surgery is a significant cause of morbidity and mortality. Standard laboratory tests fail as predictors for bleeding in the surgical setting. The use of viscoelastic (VE) hemostatic assays thromboelastography (TEG) and rotational thromboelastometry (ROTEM) could be an advantage in patients undergoing cardiac surgery. The objective of this meta-analysis was to analyze the effects (benefits and harms) of VE-guided transfusion practice in cardiac surgery patients.DesignA meta-analysis of randomized trials.SettingFor this study, PubMed, EMBASE, Scopus, and the Cochrane Collaboration database were searched, and only randomized controlled trials were included. A systematic review and meta-analysis were performed in accordance with the standards set forth by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, using a random-effects model.ParticipantsThe study comprised adult cardiac surgery patients.InterventionsVE-hemostatic assays transfusion algorithm compared with transfusion algorithms based on clinicians' discretion.Measurements And Main ResultsSeven comparative randomized controlled trials were considered, including a total of 1,035 patients (522 patients in whom a TEG- or ROTEM-based transfusion algorithm was used). In patients treated according to VE-guided algorithms, red blood cell (odds ratio 0.61; 95% confidence interval [CI]: 0.37-0.99; p: 0.04; I2: 66%) and fresh frozen plasma transfusions (risk difference 0.22; 95% CI: 0.11-0.33; p < 0.0001; I2: 79%) use was reduced; platelets transfusion was not reduced (odds ratio 0.61; 95% CI: 0.32-1.15; p: 0.12; I2 74%).ConclusionsThis study demonstrated that the use of VE assays in cardiac surgical patients is effective in reducing allogenic blood products exposure, postoperative bleeding at 12 and 24 hours after surgery, and the need for redo surgery unrelated to surgical bleeding.Copyright © 2019 Elsevier Inc. All rights reserved.

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