New Blood Test Improves Heart Outcomes
Thrombelastograph Homeostasis Analyzer, or TEG testing, is now helping physicians give patients the right balance of blood during open heart surgery.
A new lab test done before, during, and after heart surgery at Asante Rogue Regional Medical Center is helping to improve recovery for patients and lower costs. Called TEG (Thrombelastograph Homeostasis Analyzer), the specialized testing device analyzes how well a patient's blood is clotting. With this information doctors know exactly what balance of platelets, plasma, red blood cells, or other blood products the patient needs in real time. This reduces the use of surgical interventions (reoperations), drug interventions and blood products. Studies have shown that by giving patients less blood, doctors can shorten hospital stays and reduce mortality rates in high blood loss procedures such as open heart surgery.
“With TEG we have reduced blood product usage by 50-60 percent,” says David Folsom, MD, a heart surgeon with Asante Physician Partners—Cardiovascular and Thoracic Clinic. Folsom noted that the one-year mortality rate for patients increases when they have large transfusions, but TEG can lower that risk.
For example, one of Dr. Folsom's patients appeared to have post operative bleeding. It appeared he would have to return to the operating room for a repair. But a TEG test showed the patient just needed more platelets. Twenty minutes after giving platelets, the bleeding stopped. "That made a big difference in recovery for that patient," Dr. Folsom says.
According to Dr. Folsom, before TEG doctors ordered a full battery of blood products for an open heart surgery patient. This ensured they got the blood products they needed, but it also meant the patient might get more than was necessary. The hospital lab performs a TEG test before surgery to determine the patient’s normal balance. Then, during surgery, another TEG is performed. Surgery aides transport the patient specimen immediately to the lab where testing begins immediately. A computer monitor in the operating room maps a real-time graphical tracing of the hemostasis reaction taking place in the lab. The anesthesiologists, surgeon and perfusionists are able to view this schematic during surgery so they know exactly which blood product is low and exactly how much to give the patient for the best possible balance for optimum clotting. After surgery, a third test shows if the patient needs any blood products to achieve optimum clotting.
“Although not a common test, TEG testing has been incorporated at top cardiac surgery hospital programs across the country, and literature supports TEG testing during cardio-bypass surgery,” says Karen Rasmussen, medical technologist and point of care coordinator at Asante Rogue Regional. “Our cardiac surgeons have been supportive, and we have seen a sharp reduction in blood product utilization. The entire cardiac team, from the lab to the OR, has been outstanding.” The Society of Thoracic Surgeons & Cardiovascular Anesthesiologists Blood Conservation Clinical Practice Guidelines recommend monitoring platelet function for risk assessment, Rasmussen added.
"We have seen a definite reduction in reoperation and mortality rates since we started using TEG," says Karen Bales, RN, a performance improvement coordinator with Asante. Reducing how often people have to return to the operating room is a major initiative at Asante. Additionally, studies have shown the 5-year mortality rate of patients increases in relation to how much blood product is used in surgery.
“We have to limit the use of blood products without hampering safety,” she says. “We are 100 percent committed to improving patient results through best practice decisions based on meaningful data. TEG is a perfect example.”
The test is also reducing blood product costs. The average major surgery uses 2 units of blood and doctors perform about 1,200 of them a year. Reducing usage by 50 percent means 1,200 fewer units of blood each year. A significant cost savings.