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Guided blood transfusion of trauma patients with rotational thromboelastometry: a single-center cohort study

BACKGROUND: Rotational thromboelastometry (ROTEM) is a blood test used to measure in vitro clot strength as a surrogate for a patient’s ability to form clots in vivo. This provides information about induction, formation, and clot lysis, allowing goal-directed transfusion therapy for specific hemosta...

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Autores principales: Salehi, Mina, Bola, Rajan, de Jong, Nenke, Shih, Andrew W., Garraway, Naisan, Dawe, Philip
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10315024/
https://www.ncbi.nlm.nih.gov/pubmed/37393239
http://dx.doi.org/10.1186/s13017-023-00508-5
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author Salehi, Mina
Bola, Rajan
de Jong, Nenke
Shih, Andrew W.
Garraway, Naisan
Dawe, Philip
author_facet Salehi, Mina
Bola, Rajan
de Jong, Nenke
Shih, Andrew W.
Garraway, Naisan
Dawe, Philip
author_sort Salehi, Mina
collection PubMed
description BACKGROUND: Rotational thromboelastometry (ROTEM) is a blood test used to measure in vitro clot strength as a surrogate for a patient’s ability to form clots in vivo. This provides information about induction, formation, and clot lysis, allowing goal-directed transfusion therapy for specific hemostatic needs. We sought to evaluate the effect of ROTEM-guided transfusion on blood product usage and in-hospital mortality among patients with a traumatic injury. METHODS: This was a single-center observational cohort analysis of emergency department patients in a Level 1 trauma center. We compared blood usage in trauma patients in whom ratio-based massive hemorrhage protocols were activated in the twelve months before the introduction of ROTEM (pre-ROTEM group) to the twelve months following the introduction of ROTEM (ROTEM-period group). ROTEM was implemented in this center in November 2016. The ROTEM device allowed clinicians to make real-time decisions about blood product therapy in resuscitation for trauma. RESULTS: The pre-ROTEM group contained 21 patients. Forty-three patients were included from the ROTEM-period, of whom 35 patients received ROTEM-guided resuscitation (81% compliance). The use of fibrinogen concentrate was significantly higher in the ROTEM-period group (pre-ROTEM mean 0.2 vs. ROTEM-period mean 0.8; p = 0.006). There was no significant difference in the number of units of red blood cells, platelets, cryoprecipitate, or fresh frozen plasma transfused between these groups. There was no significant difference in the mortality rate between the pre-ROTEM and ROTEM-period groups (33% vs. 19%; p = 0.22). CONCLUSIONS: The introduction of ROTEM-guided transfusion at this institution was associated with increased fibrinogen usage, but this did not impact mortality rates. There was no difference in the administration of red blood cell, fresh frozen plasma, platelet, and cryoprecipitate. Future research should focus on increased ROTEM compliance and optimizing ROTEM-guided transfusion to prevent blood product overuse among trauma patients. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13017-023-00508-5.
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spelling pubmed-103150242023-07-03 Guided blood transfusion of trauma patients with rotational thromboelastometry: a single-center cohort study Salehi, Mina Bola, Rajan de Jong, Nenke Shih, Andrew W. Garraway, Naisan Dawe, Philip World J Emerg Surg Research BACKGROUND: Rotational thromboelastometry (ROTEM) is a blood test used to measure in vitro clot strength as a surrogate for a patient’s ability to form clots in vivo. This provides information about induction, formation, and clot lysis, allowing goal-directed transfusion therapy for specific hemostatic needs. We sought to evaluate the effect of ROTEM-guided transfusion on blood product usage and in-hospital mortality among patients with a traumatic injury. METHODS: This was a single-center observational cohort analysis of emergency department patients in a Level 1 trauma center. We compared blood usage in trauma patients in whom ratio-based massive hemorrhage protocols were activated in the twelve months before the introduction of ROTEM (pre-ROTEM group) to the twelve months following the introduction of ROTEM (ROTEM-period group). ROTEM was implemented in this center in November 2016. The ROTEM device allowed clinicians to make real-time decisions about blood product therapy in resuscitation for trauma. RESULTS: The pre-ROTEM group contained 21 patients. Forty-three patients were included from the ROTEM-period, of whom 35 patients received ROTEM-guided resuscitation (81% compliance). The use of fibrinogen concentrate was significantly higher in the ROTEM-period group (pre-ROTEM mean 0.2 vs. ROTEM-period mean 0.8; p = 0.006). There was no significant difference in the number of units of red blood cells, platelets, cryoprecipitate, or fresh frozen plasma transfused between these groups. There was no significant difference in the mortality rate between the pre-ROTEM and ROTEM-period groups (33% vs. 19%; p = 0.22). CONCLUSIONS: The introduction of ROTEM-guided transfusion at this institution was associated with increased fibrinogen usage, but this did not impact mortality rates. There was no difference in the administration of red blood cell, fresh frozen plasma, platelet, and cryoprecipitate. Future research should focus on increased ROTEM compliance and optimizing ROTEM-guided transfusion to prevent blood product overuse among trauma patients. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13017-023-00508-5. BioMed Central 2023-07-01 /pmc/articles/PMC10315024/ /pubmed/37393239 http://dx.doi.org/10.1186/s13017-023-00508-5 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Salehi, Mina
Bola, Rajan
de Jong, Nenke
Shih, Andrew W.
Garraway, Naisan
Dawe, Philip
Guided blood transfusion of trauma patients with rotational thromboelastometry: a single-center cohort study
title Guided blood transfusion of trauma patients with rotational thromboelastometry: a single-center cohort study
title_full Guided blood transfusion of trauma patients with rotational thromboelastometry: a single-center cohort study
title_fullStr Guided blood transfusion of trauma patients with rotational thromboelastometry: a single-center cohort study
title_full_unstemmed Guided blood transfusion of trauma patients with rotational thromboelastometry: a single-center cohort study
title_short Guided blood transfusion of trauma patients with rotational thromboelastometry: a single-center cohort study
title_sort guided blood transfusion of trauma patients with rotational thromboelastometry: a single-center cohort study
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10315024/
https://www.ncbi.nlm.nih.gov/pubmed/37393239
http://dx.doi.org/10.1186/s13017-023-00508-5
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