(1727) VETting the Data: Systematic Review of Viscoelastic Testing in Neurologic Emergencies

Introduction: Coagulopathy in neurologic emergencies often leads to complications such as bleeding or thromboembolic events, which can be mitigated with early, targeted intervention. Viscoelastographic testing (VET), including thromboelastography (TEG®) and rotational thromboelastometry (ROTEM®), offers a qualitative and quantitative assessment of coagulopathy, including fibrinolysis. This systematic review aims to determine if VET, compared to standard laboratory testing, reduces mortality, blood product transfusion, ICU, and hospital length of stay in critically ill patients with neurologic emergencies.

Methods: A systematic review following the PRISMA guidelines was conducted, registered in Prospero (CRD42022357292). Studies included were original research on adult ICU patients with neurologic emergencies. A comprehensive search was conducted across Ovid EBM Reviews, Ovid Embase, Ovid Medline, Scopus, and Web of Science Core Collection. Data extraction and risk of bias assessment were completed by two independent reviewers, with conflicts resolved by a consensus and a third author.

Results: The search yielded 756 studies, with 99 full texts reviewed, and 4 meeting inclusion criteria. The primary outcomes included all-cause mortality at 30 days and blood product transfusion rates. Baksaas-Aasen et al. reported a significant reduction in 28-day mortality with VET (44% in the VET group vs. 74% in the control group, RR 0.64; 95% CI 0.42 – 0.97). Hota et al. found mixed mortality results: moderate TBI patients had higher mortality in the VET group (RR 2.26; 95% CI 0.22 to 23.33), while severe TBI patients had lower mortality (RR 0.82; 95% CI 0.38 to 1.74). Kvint et al. showed lower hospital mortality in the VET group (RR 0.59; 95% CI 0.27 to 1.25). Of the four studies included 3 had high risk of bias and 1 had a low risk.

Conclusions: The review found that VET may be associated with reduced 28-day mortality and increased blood product utilization in traumatic brain injury patients, though results varied across studies. Despite the promising results, the heterogeneity of study designs, patient populations, and treatment regimens highlights the necessity for further research to define VET's role in clinical practice.