The evolving landscape of surgical practice is characterized by the pursuit to optimize patient outcomes while reducing costs and improving operational efficiencies- an evidence-based care improvement process referred to as Enhanced Recovery After Surgery (ERAS).1 In this context, there have been significant advancements in hemostasis testing device technology. Leading surgical practices are now harnessing the power of next-generation viscoelastic testing (VET) to individualize patient bleeding management, thereby reducing blood product transfusions by 10% up to an impressive 97%.2 This shift represents a significant departure from past practices, particularly since the landmark TRICC (Transfusion Requirements in Critical Care) trial in 1999 first reported that adverse outcomes are associated with excessive blood product transfusions.3
The urgency for blood stewardship cannot be overstated, particularly as the number of U.S. blood donors has reached an all-time low, prompting the American Red Cross to declare a national state of emergency in January 2024.4 In this challenging environment, it's imperative to adopt strategies that optimize blood usage and minimize waste. “If we could reduce over transfusions by 30 percent, that would take care of the undersupply of blood and leave blood available for patients who truly need it.” - Jonathan H. Waters MD (Professor, Departments of Anesthesiology and Perioperative Medicine and Bioengineering, University of Pittsburgh) was quoted from CAP TODAY Online.5
Recent studies have highlighted the need for improved Patient Blood Management (PBM) practices, with over-transfusion being particularly prevalent in cardiac and trauma surgery. Cardiac surgery alone accounts for an estimated 15-20% of all blood transfusions.6 The World Health Organization (WHO) has focused attention on PBM and called for every country to adopt it as standard medical practice.7 Research published by the Society of Thoracic Surgeons (STS) has linked the transfusion of a single unit of red blood cells, fresh frozen plasma or platelet concentrates, to increased post-operative complications and mortality in coronary artery bypass grafting (CABG) and aortic valve replacement (AVR) cases, emphasizing the importance of precise individualized transfusion management.8
Deppe et al. performed a systematic review and meta-analysis of 17 studies with a total of 8,332 cardiac surgery patients enrolled and compared transfusion strategy guided by VET with a control group guided by conventional coagulation testing.9 The meta-analysis found a 45% reduction in reoperations and a 23% reduction in acute kidney injury when transfusion was guided by VET. Another retrospective study of STS data examined 36,000 CABG surgeries found reoperations were associated with an additional 4.4 days in the ICU.10
After nearly two decades of evaluating various blood management strategies, guidelines and expert opinion, whole blood VET technologies have undergone a remarkable evolution, emerging as a new standard of care in goal-directed transfusion therapy.11 The latest innovations have reinvented VET into a new cartridge-based diagnostic category, offering near real-time actionable patient results that are easier to interpret and implement. Healthcare professionals can now be provided with the data they need to make informed decisions to transfuse only the necessary blood products—or none at all—which can realize significant clinical and economic benefits over time.
Addressing the overuse of blood products to manage perioperative bleeding requires whole blood point-of-care diagnostics which provide rapid comprehensive assessment of hemostatic competence. Conventional plasma-based laboratory tests often fail to deliver timely insights, leading to transfusion decisions based on “clinical judgment” often resulting in overuse. VET offers a more precise solution, enabling clinicians to determine appropriate blood component needs in real time.
Despite the advantages, adoption of first-generation legacy VET systems has been hindered by operational challenges and difficulty in interpreting results.11 Fortunately, a breakthrough has arrived in the form of the Quantra® Hemostasis System. Purposefully designed to overcome legacy VET's shortcomings, the Quantra System employs high-frequency ultrasound technology to rapidly measure the dynamics of blood clot formation.12 With its user-friendly operation and easy-to-interpret results, the Quantra empowers clinicians to promptly make patient-optimized transfusion decisions. With FDA clearance for a broad range of clinical indications, including cardiovascular and major orthopedic surgeries, trauma, and liver transplantation, the Quantra System is poised to revolutionize blood and bleeding management in surgical settings.12
In conclusion, as hospitals and healthcare systems continue to advance their patient care offerings, the Quantra System offers an innovative solution to bleeding management, enabling surgical practices to be responsible stewards of precious resources and patient health.
For more information, please visit the HemoSonics website at: https://hemosonics.com/
Authors:
Bruce Spiess, MD, FAHA, Medical Director, HemoSonics
John Friedl, BSBA, MSM, Global Marketing Director, HemoSonics
1. Ljungqvist O, Scott M, Fearon KC. Enhanced Recovery After Surgery: A Review. JAMA Surg. 2017;152:292-298.
2. Tibi P, Thompson J, Attaran S, Black E. Retrospective study assessing outcomes in cardiac surgery after implementation of Quantra. J Cardiothorac Surg. 2023;18:149.
3. Hébert PC, Wells G, Blajchman MA, et al. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials Group. N Engl J Med. 1999;340:409-417.
4. Red Cross declares emergency blood shortage, calls for donations during National Blood Donor Month. American Red Cross, Press Release January 7, 2024. https://www.redcross.org/about-us/news-and-events/press-release/2024/red-cross-declares-emergency-blood-shortage-calls-for-donations-during-national-blood-donor-month.html
5. Paxton A. Case review reveals latest on overtransfusion. CAP TODAY; March 2023. https://www.captodayonline.com/case-review-reveals-latest-on-overtransfusion/
6. Jadwin DF, Fenderson PG, Friedman MT, et al. Determination of unnecessary blood transfusion by comprehensive 15-hospital record review. Jt Comm J Qual Patient Saf. 2023;49:42-52.
7. World Health Organization. The urgent need to implement patient blood management: Policy brief. WHO Publishing 2021; Oct 19: ISBN:978-92-4-003574-4.
8. Girardi NI, Cushing MM, Evered LA, et al. Incidence and impact of a single-unit red blood cell transfusion: Analysis of The Society of Thoracic Surgeons Database 2010-2019. Ann Thorac Surg. 2023;115:1035-1041.
9. Deppe AC, Weber C, Zimmermann J, et al. Point-of-care thromboelastography/thromboelastometry-based coagulation management in cardiac surgery: a meta-analysis of 8332 patients. J Surg Res. 2016;203:424-433.
10. Mehaffey JH, Hawkins RB, Byler M, et al. Cost of individual complications following coronary artery bypass grafting. J Thorac Cardiovasc Surg. 2018;155:875-882.e1.
11. Volod O, Bunch CM , Zackariya N, et al. Viscoelastic hemostatic assays: A primer on legacy and new generation devices. J. Clin. Med. 2022;11(3):860.
12. Volod O , Viola F. The Quantra System: System description and protocols for measurements. Methods Mol Biol. 2023;2663:743-761.