Rotational thromboelastometry (ROTEM) guided treatment of an Afghanistan viper envenomation at a NATO military hospital

Roszko, Paul J D; Kavanaugh, Michael; Boese, Martin L.; Longwell, Jason J.; Earley, Angela S.

doi:10.1080/15563650.2016.1263857

Cited by 19 publications

(15 citation statements)

References 5 publications

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“…Therefore, in addition to platelet counts, multiple dynamic test systems have been developed to rapidly identify these patients including the critical administration threshold (CAT), the assessment of blood consumption (ABC) score, and other dynamic platelet function tests (diamond of death) as identified by thrombelastography (TEG). These tests have been recommended in various studies (7,(113)(114)(115)(116)(117)(118), while other studies found no evidence for benefit using TEG and ROTEM (119).…”

Section: Management Of Coagulopathymentioning

confidence: 99%

Timing of major fracture care in polytrauma patients – An update on principles, parameters and strategies for 2020

Pape

Halvachizadeh

Leenen

et al. 2019

Injury

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Objectives Sustained changes in resuscitation and transfusion management have been observed since the turn of the millennium, along with an ongoing discussion of surgical management strategies. The aims of this study are threefold: a) to evaluate the objective changes in resuscitation and mass transfusion protocols undertaken in major level I trauma centers; b) to summarize the improvements in diagnostic options for early risk profiling in multiply injured patients and c) to assess the improvements in surgical treatment for acute major fractures in the multiply injured patient. Methods I. A systematic review of the literature (comprehensive search of the MEDLINE, Embase, PubMed, and Cochrane Central Register of Controlled Trials databases) and a concomitant data base (from a single Level I center) analysis were performed. Two authors independently extracted data using a pre-designed form. A pooled analysis was performed to determine the changes in the management of polytraumatized patients after the change of the millennium. II. A data base from a level I trauma center was utilized to test any effects of treatment changes on outcome. Inclusion criteria: adult patients, ISS > 16, admission < less than 24 h post trauma. Exclusion: Oncological diseases, genetic disorders that affect the musculoskeletal system. Parameters evaluated were mortality, ICU stay, ICU complications (Sepsis, Pneumonia, Multiple organ failure). Results I. From the electronic databases, 5141 articles were deemed to be relevant. 169 articles met the inclusion criteria and a manual review of reference lists of key articles identified an additional 22 articles. II. Out of 3668 patients, 2694 (73.4%) were male, the mean ISS was 28.2 (SD 15.1), mean NISS was 37.2 points (SD 17.4 points) and the average length of stay was 17.0 days (SD 18.7 days) with a mean length of ICU stay of 8.2 days (SD 10.5 days), and a mean ventilation time of 5.1 days (SD 8.1 days). Both surgical management and nonsurgical strategies have changed over time. Damage control resuscitation, dynamic analyses of coagulopathy and lactate clearance proved to sharpen the view of the worsening trauma patient and facilitated the prevention of further complications. The subsequent surgical care has become safer and more balanced, avoiding overzealous initial surgeries, while performing early fixation, when patients are physiologically stable or rapidly improving. Severe chest trauma and soft tissue injuries require further evaluation. Conclusions Multiple changes in management (resuscitation, transfusion protocols and balanced surgical care) have taken place. Moreover, improvement in mortality rates and complications associated with several factors were also observed. These findings support the view that the management of polytrauma patients has been substantially improved over the past 3 decades.

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Section: Management Of Coagulopathymentioning

confidence: 99%

Timing of major fracture care in polytrauma patients – An update on principles, parameters and strategies for 2020

Pape

Halvachizadeh

Leenen

et al. 2019

Injury

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“…This lack of baseline data is a major barrier to studying thromboelastography for this application. There have been case reports or small case series of thromboelastography in rattlesnake envenomation but many have been from outside of North America [12][13][14][15] and details about methodology were not always included (e.g., citrated versus whole blood, which activator used, etc.). Moreover, all studies, whether from North America [16][17][18] or not, have reported only standard thromboelastography, which do not include platelet activation studies.…”

Section: Introductionmentioning

confidence: 99%

Thromboelastography with Platelet Studies (TEG® with PlateletMapping®) After Rattlesnake Envenomation in the Southwestern United States Demonstrates Inhibition of ADP-Induced Platelet Activation As Well As Clot Lysis

Kang

Fisher

2019

J. Med. Toxicol.

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Introduction Hematologic effects of North American rattlesnake envenomation can include fibrinogenolysis and thrombocytopenia, depending on species, geography, and other variables. During treatment, these effects are routinely monitored through assessment of fibrinogen concentrations and platelet counts. However, these tests provide no information about fibrinolysis or platelet dysfunction, both of which can also occur with venom from some species. Methods This was a retrospective chart review of patients admitted to a quaternary care academic hospital (Banner -University Medical Center Phoenix) in the southwestern United States for treatment of rattlesnake envenomation, over an approximately 1year period from March 2017 through April 2018. Patients who had thromboelastography with platelet studies (TEG® with PlateletMapping®) during their care were included. Results Twelve patients were identified for this study. Four patients exhibited inhibition of ADP-induced platelet activation: one had normal fibrinogen and platelet count, two had concurrent hypofibrinogenemia, and one had concurrent thrombocytopenia. Crotalidae polyvalent immune Fab (ovine) reversed platelet inhibition in the single patient for whom serial thromboelastographs were available. Fibrinolysis was present in seven patients and resolved in the two patients with serial thromboelastographs. Conclusions Inhibition of ADP-induced platelet aggregation and fibrinolysis occurred independent of hypofibrinogenemia and thrombocytopenia, indicating fibrinogen concentration (or protime) and platelet count monitoring alone is insufficient to assess the extent of hematologic toxicity in rattlesnake envenomation. Crotalidae polyvalent immune Fab (ovine) reversed platelet inhibition in one case, suggesting platelet inhibition could also be used in treatment decisions. Fibrinolysis could also be reversed, although the timing to antivenom administration was less clear.

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“…TEG showed a difference in data tracings. 9 Additional case reports have reported using ROTEM or TEG in the assessment and management of North American pit viper envenomation, 10,11 probable Echis envenomation in Afghanistan, 12 viper envenomation in India, 13 snake envenoming with coagulopathy in Djibouti, 14 and coagulopathy associated with Viperidae envenoming in Vietnam. 15 The largest series using TEG is from South Africa, where 51 cases were reviewed.…”

Section: Discussionmentioning

confidence: 99%

Case Report: Rotational Thromboelastometry in Taipan Envenomation

Tacon

Munas

Little

2022

The American Journal of Tropical Medicine and Hygiene

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Venom-induced consumption coagulopathy (VICC) is one of the most dangerous syndromes caused by snake envenomation and can be caused by several snake species worldwide, including the Australian coastal taipan. Rotational thromboelastometry (ROTEM) provides real-time point-of-care information on all stages of clot formation; however, it has yet to be formally evaluated in the assessment of VICC. We report three cases of Taipan envenomation causing VICC and the associated ROTEM results. The implications for future use of ROTEM in the assessment, management, and further research of VICC are discussed.

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Rotational thromboelastometry (ROTEM) guided treatment of an Afghanistan viper envenomation at a NATO military hospital

Cited by 19 publications

References 5 publications

Timing of major fracture care in polytrauma patients – An update on principles, parameters and strategies for 2020

Timing of major fracture care in polytrauma patients – An update on principles, parameters and strategies for 2020

Thromboelastography with Platelet Studies (TEG® with PlateletMapping®) After Rattlesnake Envenomation in the Southwestern United States Demonstrates Inhibition of ADP-Induced Platelet Activation As Well As Clot Lysis

Case Report: Rotational Thromboelastometry in Taipan Envenomation

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