Background: The monitoring of haemostasis and anticoagulation in paediatric patients receiving Extra-corporeal Life Support (ECLS) is vital for safe patient care, yet there is a lack of evidence underlying practice and no consensus on the best approach. All established methods have weaknesses and have been shown to correlate poorly with each other, and with heparin activity. Viscoelastic haemostatic assays (VHA) are increasingly used to direct treatment for patients at high risk of bleeding. Research to date has primarily focused on how VHA compares to standard laboratory tests, or on specific variables, such as the use of transfusion products. There is a paucity of qualitative research on how physicians incorporate this technology into clinical decision making in ‘real world’ acute scenarios.

Aims: This study aims to explore how the availability of TEG 6S influences clinical decision making for children on ECLS in a paediatric intensive care unit (PICU).

Methods: This qualitative study took a phenomenological approach. Purposive sampling was used to identify consultants using thromboelastography (TEG) to manage children in the PICU at Bristol Royal Hospital for Children. Semi-structured interviews invited the participants to discuss their ‘lived experience’ of how TEG is incorporated into clinical decision making. Thematic analysis of interview scripts identified a collection of core themes.

Results: Final analysis identified several themes which are evidenced by quotes and short narratives. End users emphasised the importance of real-time supportive data and increased confidence in clinical decisions, particularly when other assays showed discrepant results.

Conclusions: The addition of TEG into the monitoring of haemostasis and anticoagulation in children requiring ECLS gives clinicians the ability to unpick complex situations in “real time” and leads to greater confidence in clinical decision-making.

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/how-does-the-availability-of-thromboelastography-influence-clinical-reasoning-in-a-paediatric-intensive-care-unit-a-narrative-view/