Feasibility of Using Rotational Thromboelastometry to Assess Coagulation Status of Combat Casualties in a Deployed Setting

Doran, Catherine; Woolley, Tom; Midwinter, Mark J.

doi:10.1097/ta.0b013e3181e4257b

Cited by 90 publications

(83 citation statements)

References 16 publications

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“…6,7 Furthermore, thromboelastography (either thromboelastogram [TEG] or rotational thromboelastrometry) began to be used to guide resuscitation. 8,9 By 2010, essentially 100% of massive transfusions administered in the combat theater were balanced in a 1:1:1 (plasma:platelet:RBC) ratio. 5 The DCR concept advocated decreasing crystalloid use to a minimum and using blood products as the primary resuscitative fluid.…”

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confidence: 99%

Optimal trauma resuscitation with plasma as the primary resuscitative fluid: the surgeon's perspective

Holcomb¹,

2013

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Over the past century, blood banking and transfusion practices have moved from whole blood therapy to components. In trauma patients, the shift to component therapy was achieved without clinically validating which patients needed which blood products. Over the past 4 decades, this lack of clinical validation has led to uncertainty on how to optimally use blood products and has likely resulted in both overuse and underuse in injured patients. However, recent data from both US military operations and civilian trauma centers have shown a survival advantage with a balanced transfusion ratio of RBCs, plasma, and platelets. This has been extended to include the prehospital arena, where thawed plasma, RBCs, and antifibrinolytics are becoming more widely used. The Texas Trauma Institute in Houston has followed this progression by putting RBCs and thawed plasma in the emergency department and liquid plasma and RBCs on helicopters, transfusing platelets earlier, and using thromboelastogram-guided approaches. These changes have not only resulted in improved outcomes, but have also decreased inflammatory complications, operations, and overall use of blood products. In addition, studies have shown that resuscitating with plasma (instead of crystalloid) repairs the "endotheliopathy of trauma," or the systemic endothelial injury and dysfunction that lead to coagulation disturbances and inflammation. Data from the Trauma Outcomes Group, the Prospective Observational Multicenter Major Trauma Transfusion (PROMMTT) study, and the ongoing Pragmatic Randomized Optimal Platelet and Plasma Ratios (PROPPR) trial represent a decade-long effort to programmatically determine optimal resuscitation practices, balancing risk versus benefits. With injury as the leading cause of death in patients age 1 to 44 years and hemorrhage the leading cause of potentially preventable death in this group, high-quality data must be obtained to provide superior care to the civilian and combat injured.

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confidence: 99%

Optimal trauma resuscitation with plasma as the primary resuscitative fluid: the surgeon's perspective

Holcomb¹,

2013

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“…The use of viscoelastic coagulation monitoring may help answer some questions over the optimal timing of VTE prophylaxis with respect to hypercoagulability following trauma. 33,46 TEG has shown some potential as a more sensitive indicator of hypercoagulability following trauma, 46 and further studies are urgently required to understand more about the medium-term impact of hemostatic resuscitation and the transition from coagulopathy to hypercoagulability.…”

Section: Hypercoagulability and Thromboprophylaxis After Traumamentioning

confidence: 98%

“…After the initial evaluation of ROTEM in the United Kingdom, a feasibility study was conducted in Bastion R3 from January to March 2009. 33 The aim of this work was to assess the suitability of ROTEM for the deployed setting, considering the environment and available personnel, with the overall aim of determining whether ROTEM could be helpful in the assessment and management of coagulopathy in military trauma patients.…”

Section: Rotem In the Deployed Field Hospitalmentioning

confidence: 99%

Evolution of coagulopathy monitoring in military damage-control resuscitation

Tarmey¹,

Woolley²,

Jansen³

et al. 2012

Journal of Trauma and Acute Care Surgery

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“…Screens are easily visible during surgery and staff trained to run samples frequently and efficiently. 25 They are now part of routine practice for the immediate management of coagulopathy in battlefield trauma. For MOH more research is required to establish whether this type of monitoring can have an impact on both clinical and cost effectiveness, mortality and especially morbidity.…”

Section: Monitoring Coagulationmentioning

confidence: 99%

Monitoring transfusion requirements in major obstetric haemorrhage: out with the old and in with the new?

Stocks¹

2011

International Journal of Obstetric Anesthesia

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Feasibility of Using Rotational Thromboelastometry to Assess Coagulation Status of Combat Casualties in a Deployed Setting

Abstract: It is feasible to use TEM in a deployed military setting. We have shown that rotational thromboelastometry significantly detects more abnormalities in the coagulation status than the standard laboratory tests (prothrombin time, and activated partial thromboplastin time).

Cited by 90 publications

References 16 publications

Optimal trauma resuscitation with plasma as the primary resuscitative fluid: the surgeon's perspective

Optimal trauma resuscitation with plasma as the primary resuscitative fluid: the surgeon's perspective

Evolution of coagulopathy monitoring in military damage-control resuscitation

Monitoring transfusion requirements in major obstetric haemorrhage: out with the old and in with the new?

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