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. 2025 May;39(5):1162-1172.
doi: 10.1053/j.jvca.2025.02.011. Epub 2025 Feb 8.

TEG® 6s-Guided Algorithm for Optimizing Patient Blood Management in Cardiovascular Surgery: Systematic Literature Review and Expert Opinion

Courtney Maxey-Jones  1 , Troy G Seelhammer  2 , Francisco A Arabia  3 , Brian Cho  4 , Bradford Cardonell  5 , Daniel Smith  6 , Vincenzo Leo  7 , Joao Dias  7 , Linda Shore-Lesserson  8 , Jan Hartmann  9
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Free article

TEG® 6s-Guided Algorithm for Optimizing Patient Blood Management in Cardiovascular Surgery: Systematic Literature Review and Expert Opinion

Courtney Maxey-Jones et al. J Cardiothorac Vasc Anesth. 2025 May.
Free article

Abstract

Objectives: To propose a comprehensive TEG 6s-based intraoperative and/or immediately postoperative treatment algorithm for bleeding patients undergoing cardiac surgery. To achieve this, TEG-based treatment algorithms in cardiac surgery were evaluated through a literature review and structured expert opinion.

Design: Systematic literature review.

Setting: Cardiac surgery.

Participants: Adult patients undergoing cardiac surgery with intraoperative and/or immediately postoperative bleeding.

Interventions: TEG-guided transfusion algorithm.

Measurements and main results: A literature search was conducted for original studies reporting TEG-based treatment algorithms in cardiac surgery settings. Of 304 identified manuscripts, fourteen met all inclusion criteria, with two further articles identified through authors' suggestions. There is limited evidence describing the use of TEG 6s assays in cardiac surgery with only one study reporting a dedicated algorithm using the TEG 6s device at a non-US center. Two additional studies assessed TEG 6s assays. The remaining manuscripts reported algorithms based on the TEG 5000 device. Following the author's review of the available data, and feedback from expert opinion, a simple transfusion algorithm was proposed as an initial framework for developing a TEG 6s-based protocol with consideration for the 2021 Society of Thoracic Surgery/Society of Cardiovascular Anesthesiologists/American Society of Extracorporeal Technology/Society for the Advancement of Patient Blood Management Patient Blood Management Guidelines.

Conclusions: A new algorithm for cardiac surgery based on TEG 6s assays has been proposed based on the available evidence and expert opinion for research alignment and clinical validation.

Keywords: PBM; TEG 6s; cardiac surgery; hemostasis; patient blood management; thromboelastography; transfusion.

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Conflict of interest statement

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Courtney Maxey-Jones reports financial support was provided by Haemonetics Corporation. Troy G. Seelhammer reports financial support was provided by Haemonetics Corporation. Francisco A. Arabia reports financial support was provided by Haemonetics Corporation. Brian Cho reports financial support was provided by Haemonetics Corporation. Bradford Cardonell reports financial support was provided by Haemonetics Corporation. Daniel Smith reports financial support was provided by Haemonetics Corporation. Vincenzo Leo reports financial support was provided by Haemonetics Corporation. Joao Dias reports financial support was provided by Haemonetics Corporation. Linda Shore-Lesserson reports financial support was provided by Haemonetics Corporation. Jan Hartmann reports financial support was provided by Haemonetics Corporation. Courtney Maxey-Jones reports a relationship with AbioMed Inc that includes: speaking and lecture fees. Courtney Maxey-Jones reports a relationship with AtriCure Inc that includes: speaking and lecture fees. Brian Cho reports a relationship with Edwards Lifesciences Corporation that includes: consulting or advisory and speaking and lecture fees. Bradford Cardonell reports a relationship with Haemonetics Corporation that includes: speaking and lecture fees. Linda Shore-Lesserson reports a relationship with Werfen that includes: consulting or advisory. Vincenzo Leo reports a relationship with Haemonetics Corporation that includes: employment. Joao Dias reports a relationship with Haemonetics Corporation that includes: employment. Jan Hartmann reports a relationship with Haemonetics Corporation that includes: employment. No further COI to disclose - DS If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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