Multi-centre investigation on reference ranges for ROTEM thromboelastometry

Lang, Thomas; Bauters, Anne; Braun, Siegmund; Pötzsch, Bernd; Pape, Klaus-Werner von; Kolde, Hans-Jürgen; Lakner, Meret

doi:10.1097/01.mbc.0000169225.31173.19

Cited by 464 publications

(435 citation statements)

References 32 publications

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“…One striking finding was that the analysis population had a median of 5/28 test results per patient that were abnormal (range 0‐18) when compared to healthy control reference intervals, which were similar in our study to previously published reference intervals 37, 38, 39…”

Section: Discussionsupporting

confidence: 89%

Near‐patient coagulation testing to predict bleeding after cardiac surgery: a cohort study

Mumford

Harris

Plummer

et al. 2017

Research and Practice in Thrombosis and Haemostasis

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Essentials Near‐patient testing improves coagulopathy diagnosis in cardiac surgery patients with severe bleeding.We investigated how well pre‐emptive near‐patient testing predicted severe bleeding.Severe bleeding could be predicted using both near‐patient tests and patient clinical characteristics.Near‐patient test results gave little additional predictive value over clinical characteristics alone. BackgroundCoagulopathic bleeding is common after cardiac surgery and is associated with increased morbidity, mortality and healthcare costs. Implementation of blood management algorithms in which patients with severe bleeding undergo near‐patient coagulation testing results in less overall bleeding and transfusion. However, it is unknown whether there is additional value from pre‐emptive near‐patient testing to predict whether severe bleeding will occur.ObjectivesTo evaluate how well a comprehensive panel of 28 near‐patient platelet and viscoelastometry tests predict bleeding after cardiac surgery, compared to prediction using baseline clinical characteristics alone.MethodsSingle‐center, prospective cohort study in adults undergoing a range of cardiac surgery procedures. The primary outcome was clinical concern about bleeding (CCB), a composite of high blood loss (chest drain volume >600 mL within 6 hours), re‐operation for bleeding or administration of a pro‐haemostatic treatment directed by clinician judgement.ResultsIn 1833 patients recruited between March 2010 and August 2012, the median number of abnormal near‐patient test results was 5/28 per patient (range 0‐18). CCB occurred in 449/1833 patients (24.5%). The c‐statistic for a predictive model for CCB using only baseline clinical characteristics (baseline‐only model) was 0.72 (95% CI 0.69‐0.75). Addition of near‐patient test results to this model (baseline‐plus‐test model) improved the prediction of CCB (c‐statistic 0.75 [0.72‐0.77]), but increased the number of correctly classified patients by only 18 (0.98%).ConclusionsNear‐patient coagulation testing predicts bleeding in cardiac surgery patients, but offers little improvement in prediction compared to baseline clinical characteristics alone. trial registration: ISRNCTN 20778544 (http://www.isrctn.com/).

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Section: Discussionsupporting

confidence: 89%

Near‐patient coagulation testing to predict bleeding after cardiac surgery: a cohort study

Mumford

Harris

Plummer

et al. 2017

Research and Practice in Thrombosis and Haemostasis

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“…The FIBTEM evaluates the fibrinogen component (concentration and contribution to the clot formation) by using a platelet inhibitor (cytochalasine D). 13 The methods used and parameters for thrombelastography have been previously described in detail. 13,14 In brief, thrombelastography measures the firmness of a blood clot during clot formation and subsequent fibrinolysis.…”

Section: The Modified Rotation Thrombelastometrymentioning

confidence: 99%

“…13 The methods used and parameters for thrombelastography have been previously described in detail. 13,14 In brief, thrombelastography measures the firmness of a blood clot during clot formation and subsequent fibrinolysis. The ROTEM generates a reaction curve in real time …”

Section: The Modified Rotation Thrombelastometrymentioning

confidence: 99%

Bedside assessment of fibrinogen level in postpartum haemorrhage by thrombelastometry

Huissoud

Carrabin

Audibert

et al. 2009

BJOG

204

161

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Objectives To establish whether reagent-supported thrombelastometry with the rotation thrombelastometry system (ROTEM Ò ) point-of-care device correlated with fibrinogen level in postpartum haemorrhages.Design Prospective observational study.Population and setting Ninety-one women at the third trimester of pregnancy: 37 with postpartum haemorrhage (study group) and 54 without abnormal bleeding (control group).Methods Standard laboratory test results were compared with those obtained at bedside from the ROTEM with the FIBTEM Ò test (54 tests in the control group and 51 in the study group). Results Median fibrinogen level was significantly lower in the haemorrhage group than in the control group (3.4 and 5.1 g/l, respectively, P < 0.0001). Median CT was higher in the haemorrhage group than in the control group (P = 0.05). CA 5 , CA 15 and MCF were significantly lower in the haemorrhage group than in controls (P < 0.0001) and strongly correlated with fibrinogen levels in both groups (r = 0.84-0.87, P < 0.0001). A cut-off value of CA 5 at 5 mm and CA 15 at 6 mm presented an excellent sensitivity (100% for both parameters) and a good specificity (respectively 85 and 88%) to detect fibrinogen levels <1.5 g/l in postpartum haemorrhage.Conclusions The early parameters obtained from the FIBTEM test correlated well with fibrinogen levels. ROTEM might be helpful in guiding fibrinogen transfusion during postpartum haemorrhage.

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“…This difference was due to the availability of only two ROTEM ® devices. However, prior publications show stability of blood samples until 4 h after sampling (15,17) . In addition, our results show a difference already between manual and standard " priority " mode and this difference slightly increases with acceleration and rotation forces.…”

Section: Discussionmentioning

confidence: 95%

“…Non-parametric statistic was applied and performed with SPSS Statistics Version 19 © software (SPSS Inc., Chicago, All results of the ROTEM ® analysis of sample A were within normal range (Table 3 ) (15) . Transport through the pneumatic tube system with a low velocity of 3 m/s (according to local standard " priority " mode, sample B) produce minimal but statistically signifi cant changes in multiple parameters of EXTEM (A10, A15, A30, MCF and AUC, Table 3) and one parameter of INTEM and APTEM (A30, Table 3).…”

Section: Discussionmentioning

confidence: 99%

Effect of acceleration forces during transport through a pneumatic tube system on ROTEM® analysis

Amann

Zehntner²,

Marti³

et al. 2012

Clinical Chemistry and Laboratory Medicine

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Background: ROTEM ® is considered a helpful point-of-care device to monitor blood coagulation in emergency situations. Centrally performed analysis is desirable but rapid transport of blood samples is an important prerequisite. The effect of acceleration forces on sample transport through a pneumatic tube system on ROTEM ® should be tested at each institution to exclude a pre-analytical infl uence. The aims of the present work were: (i) to investigate the effect of pneumatic tube transport on ROTEM ® parameters; (ii) to compare blood sample transport via pneumatic tube vs. manual transportation; and (iii) to determine the effect of acceleration forces on ROTEM ® parameters. Methods: This is a single centre study with 20 healthy volunteers. Five whole blood samples were transferred to the central haematology laboratory by either normal transport or pneumatic delivery with different speed and acceleration forces. EXTEM, INTEM, FIBTEM and APTEM were analysed in parallel with two ROTEM ® devices and compared. Acceleration forces were measured during transport with two different instruments. Results: Increment of transport time, speed and distance resulted in an augmentation of acceleration forces and peaks. All results of the ROTEM ® analysis after manual transport or pneumatic delivery were within normal range. However, increase in acceleration forces resulted in minimally but statistically signifi cant changes in multiple ROTEM ® parameters. The higher the acceleration forces, the more ROTEM ® parameters are infl uenced. Conclusions: Acceleration forces during transport through a pneumatic tube system have an infl uence on ROTEM ® parameters. Prior to transfer blood samples via pneumatic tube system these infl uences should be tested to exclude clinically relevant blood coagulation activation in vitro.

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Multi-centre investigation on reference ranges for ROTEM thromboelastometry

Cited by 464 publications

References 32 publications

Near‐patient coagulation testing to predict bleeding after cardiac surgery: a cohort study

Near‐patient coagulation testing to predict bleeding after cardiac surgery: a cohort study

Bedside assessment of fibrinogen level in postpartum haemorrhage by thrombelastometry

Effect of acceleration forces during transport through a pneumatic tube system on ROTEM® analysis

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