NICE has endorsed two devices to help with problems during cardiac surgery.
The two viscoelastometric testing devices – the ROTEM system (TEM International) and the TEG system (Haemonetics) – will help to detect life-threatening bleeding during and after cardiac surgery.
The guidance by NICE
(the National Institute for Health and Clinical Excellence) also recommends further research for the use of viscoelastometric testing for managing emergency bleeding in cases of trauma and post-partum haemorrhage because the technologies show promise.
During surgery the blood clotting process (haemostasis) can be disrupted (coagulopathy), resulting in excessive and sometimes life-threatening blood loss. Coagulopathy can occur in a variety of clinical situations including liver transplantation, cardiac surgery, vascular surgery, postpartum haemorrhage and severe trauma. But coagulopathy cannot currently be easily detected by laboratory coagulation testing.
Viscoelastometric point-of-care testing is a blood test that may be used to determine whether bleeding is a result of coagulopathy or a surgical bleed. It is mainly used in adults who are having major surgery that is associated with high blood loss, such as cardiac surgery, or in adults undergoing emergency surgery for trauma or post-partum haemorrhage. Viscoelastometric testing helps guide the clinician to select the most appropriate treatment to stop the bleeding.
Patients with serious bleeding usually require a blood transfusion and/or re-operation. Cardiac surgery uses approximately 15% of all donated blood in the UK, and of the 30,000 patients who undergo cardiac surgery each year in the UK, as many as 1200 require re-operation for bleeding.
Professor Carole Longson, NICE Health Technology Evaluation Centre Director, said: "Current laboratory testing is only able to identify when blood is not clotting properly, not what part of the clotting process is disrupted. By using these new tests, clinicians will be able to determine what has caused a bleed and tailor treatment to the cause of the coagulopathy rather than replacing blood with transfusion, or undertaking a further operation.
"The evidence shows that not only is the use of these tests associated with fewer deaths, but also a reduced probability of experiencing complications, fewer transfusions and lower hospitalisation costs."
The guidance also recommends that further research is carried out into the clinical benefit and cost effectiveness of using a further system – Sonoclot (Sienco Inc.) - for the same indication. Further research was also recommended for the use of all 3 devices in the management of emergency bleeding in cases of trauma and post-partum haemorrhage.