A Systematic Review And Meta-Analysis Of Goal Directed Intra-Operative Transfusion Protocols Guided By Viscoelastic Methods And Perioperative Outcomes In Children [Crd 42018103163].

Introduction: In children studies have shown that when viscoelastic hemostatic methods were used to guide blood product administration in hemorrhagic surgery, the amount of transfusion was diminished, it has not been demonstrated that morbi-mortality was improved. This study was undertaken to analyse the impact of these methods on this outcome.

Methods: A systematic review and meta-analysis of randomised and non randomised trials was realised from January to March 2019.The experimental group was where thromboleastography or rotational thromboelastometry were used to guide transfusion. The control group was where conventional coagulation tests were used to guide transfusion. Statistic analysis was realised with Rev Man 5.3 software.

Results: 9 studies with 1365 children <1 8 years in trauma , cardiac, craniosynostosis and liver transplantation surgery were included.

1. In more than 900 children, mortality (OR 1.02 [0.34, 3.10], p=0.97) and morbidity (OR 1.95 [0.75,5.11],p=0.17) were not different.
2. In 891 children, the number of patients transfused with packed red blood cells was not different, OR 0.44 [0.18, 1.06], p=0.07.
3. In 227 children, the number of patients transfused with platelets was not different, OR 0.90 [0.08, 9.94], p=0.93.
4. In 891 children, the number of patients transfused with fresh frozen plasma was lower in the experimental group, OR 0.06 [0.01, 0.50], p=0.01.
5. In 185 children, the number of patients who received fibrinogen or cryoprecipitate was higher in the experimental group, OR 5.46 [1.83, 16.32], p=0.002.
6. In 821 children, length of hospital stay was lower in the experimental group, p=0.005.   

           Conclusion: In this pediatric study, when viscoelastic hemostatic assays were used in hemorrhagic surgery to guide transfusion there was a reduction in the number of patients intraoperatively transfused with fresh frozen plasma, a reduction in length of hospital stay and an increase in the number of patients who received intraoperative cryoprecipitate or fibrinogen. There was no difference in morbi-mortality.