A Cohort, Semi-Randomized, Open Label Quality Improvement Patient Blood Management (PBM) Comparison of Point of Care Viscoelastic Coagulation Monitors in Cardiac Surgery

Abstract Purpose: Viscoelastic testing (VET), recommended for heart surgery, has not been adopted due to lack of timely point of care (POC) technology. Several POC VET devices have become available. The purposes of this quality initiative (QI), part of a patient blood management program-PBM), were to: 1) Compare two POC VET for timeliness 2) Survey need, ease of use, acceptability, and set up for the on-going PBM program. Methods: The TEG-6s and the Quantra Q-plus Hemostasis Analyzer, were assessed in cardiac patients (n = 68) over a six-week period (May 15 -June 30, 2021). Timeliness of data acquisition was analyzed. Algorithms to assist physicians in therapeutic interventions were created. Cardiac members answered quality assessment surveys. Impacts on blood ordering were analyzed compared to a corresponding 6-week period pre COVID-19 epidemic. Results: Prior to the QI initiative, respondents noted time problems for laboratory coagulation analysis and acquisition of blood products. TEG 6s reporting time was 24.9 +/-4 minutes. Quantra Qplus required 49% less time, 12.9 +/- 1.3 minutes (PConclusions: We describe head-to-head testing prior to implementation as the next step in PBM QI. Quantra Qplus was twice as fast. Clinicians preferred the speed, ease of use, and interpretability of the Quantra. Large studies are needed to investigate the PBM benefit of POC VET.