Does Thromboelastography in Non-trauma Critical Care Patients Promote the Judicious Use of Blood Products?

Background: Thromboelastography (TEG) revolutionized the resuscitation of critically ill trauma and cirrhotic patients by improving blood product utilization and survival outcomes. There is limited data on the application and outcomes of non-trauma critical care (NTCC) patients with TEG use. This study compares the blood product utilization, mortality, and other outcomes of NTCC patients using TEG or CCT-guided transfusion. Methods: This is a single-center retrospective observational exploratory study of adult NTCC patients admitted to the medical intensive care unit in a rural academic center. Eligible patients received transfusion of blood products (BPs) guided by CCT or TEG studies. The primary outcome compared BPs transfused. Secondary outcomes included methods to achieve hemostasis, 28-day readmission rate after discharge, and 28-day survival. Results: TEG was used in 80 (70.8%) patients. The TEG group received 4.5 more units of BPs than the CCT group (p=0.003). A clinically significant difference in BPs transfused was seen in packed red blood cells (p=0.064), platelets (p=0.003), and fresh frozen plasma (p=0.020). The methods to achieve hemostasis between the groups were statistically significant (p=0.021). The 28-day readmission-free rate was similar (42.5% vs. 54.5%, TEG vs. CCT, p=0.301), as was the 28-day survival after discharge (p=0.078) in both groups. Conclusions: TEG-guided transfusion increased the number of BPs transfused compared to CCT in NTCC patients. No difference between the two groups in achieving hemostasis, 28-day readmission rate, or 28-day mortality was observed. This study highlights the need to further analyze TEGguided resuscitation prior to adopting TEG into routine practice in NTCC settings.