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The Use of Thromboelastography in Obstetric Anesthesiology: A Survey of Current Practice
Abstract Number: SA-07
Abstract Type: Original Research
Introduction: Thromboelastography (TEG) is an in-vivo point of care hemostatic test that assesses both coagulation and fibrinolysis. It has been used to guide clinical decision making in a variety of situations by obstetric anesthesiologists. We sought to identify practice patterns and areas for further research which may help broaden the use of TEG in our specialty.
Methods: After obtaining IRB approval, an electronic survey via Survey Monkey® (www.surveymonkey.com) was sent to all members of the Society for Obstetric Anesthesiology and Perinatology (SOAP) in April 2015. Chi-square analysis was performed to identify significant practice differences among the various sub groups. P value <0.05 was considered significant.
Results: A total of 180 responses were received from the 1,058 recipients of the request. Of the providers that responded, 156 (88%) were practicing in the United States. 130 (73%) report practicing at academic hospitals, 44 (25%) at non-academic hospitals. Nearly 67% (117) do not use TEG during their practice. Of the 58 providers who indicated that they use TEG, 53 identified as practicing at academic hospitals. Providers at academic hospitals were significantly more likely to use TEG than those practicing in non-academic hospitals (p value <.01). Of the providers not using TEG, 73%, (87) gave their reason as “not available at their institution”, with 41 of 44 respondents at non-academic hospitals giving that reason. The predominant use for TEG is to assist in management of hemorrhage (75% of users), though 39% also use it to assess a patient prior to neuraxial blockade.
Conclusion: TEG in obstetric anesthesia appears to be predominately used by those practicing at academic hospitals. TEG is limited by its availability to providers at the institutions in which they practice, though unfamiliarity with the its use and the belief that there is not enough evidence to support its use also limit utilization. Clinicians are using TEG mostly to assist in management of hemorrhage, but also to assess for placement of neuraxial anesthesia. TEG has been shown to be a useful and feasible tool in obstetric anesthesia particularly for hemorrhage management (1-2). However, despite this evidence, its use is still limited even within the academic setting. Future studies validating the utility of TEG in obstetric hemorrhage management and examining its validity in guiding neuraxial anesthesia are needed before widespread adoption in anesthesia practice occurs.
1) Ekelund K, Hanke G, Stensballe J, Wikkelsøe A, Albrechtsen CK, Afshari A. Hemostatic resuscitation in postpartum hemorrhage – a supplement to surgery. Acta Obstet Gynecol Scand 2015; 94: 680–692.
2) Hill JS, Devenie G, Powell M. Point-of-care testing of coagulation and fibrinolytic status during postpartum haemorrhage: developing a thromboelastography- guided transfusion algorithm. Anaesth Intensive Care 2012 Nov;40(6):1007-15.