Rotational thrombolelastometry produces potentially clinical useful results within 10 min in bleeding Emergency Department patients

Reed, Matthew J; Nimmo, A. F.; McGee, Danny; Manson, Lynn; Neffendorf, Alice E.; Moir, Linzi; Donaldson, Lucienne S

doi:10.1097/mej.0b013e3283561261

Cited by 15 publications

(10 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, A5 and A10 need not be seen only as surrogates for MCF. To our knowledge, although the correlation of A5 and A10 with MCF has been studied , MCF has not yet been demonstrated as superior to A5 or A10 for predicting clinical outcome.…”

Section: Discussionmentioning

confidence: 98%

“…We focused on A5, A10 and MCF using the EXTEM assay . We used scatter plots and Spearman correlation coefficients to examine the relationship of A5 and A10 with MCF.…”

Section: Methodsmentioning

confidence: 99%

“…A reduced maximum clot firmness (MCF) has been used as a trigger for administration of blood products , but it can take up to 25–29 min to obtain this measurement . For this reason, some researchers in trauma and in peri‐operative medicine have investigated whether clot firmness at 5 min (A5) or 10 min (A10) are acceptable substitutes. Meyer et al found A10, but not A5, to correlate better with laboratory tests than MCF , and they suggested that early clot amplitude measurements may in fact ‘ reflect a more dynamic part of the haemostatic process ’ than MCF.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Using rotational thromboelastometry clot firmness at 5 minutes (ROTEM^® EXTEM A5) to predict massive transfusion and in‐hospital mortality in trauma: a retrospective analysis of 1146 patients

et al. 2018

View full text Add to dashboard Cite

SummaryViscoelastic assays such as TEG ® and ROTEM ® are increasingly used to guide transfusion of blood products. The EXTEM assay maximum clot firmness (MCF) is a ROTEM measure available after 25–29 min used to guide early decisions. EXTEM A10, the clot firmness at 10 min, is an accepted early surrogate, but investigators differ on whether A5, the clot firmness at 5 min, is acceptable. We re‐examined this in a retrospective observational analysis of 1146 trauma patients in one centre who had ROTEM data recorded. A5 and A10 both correlated well with maximum clot firmness, with Pearson coefficients of r = 0.92 and r = 0.96, respectively. The correlations of A5, A10 and maximum clot firmness with requirement for massive transfusion were all similarly high, with c‐stats of 0.87, 0.89 and 0.90, respectively. The correlations with mortality were also similar but weaker, with c‐stats of 0.67, 0.69 and 0.69, respectively. Using a previously validated cut‐off of A5 < 35 mm to predict massive transfusion gave a sensitivity of 95%, specificity 83%, positive predictive value 9.3% and negative predictive value 100%. Using a value of A5 < 29 mm, for a pragmatic positive predictive value of 20%, gave a sensitivity of 67%, specificity 95% and negative predictive value 99%. Whether aiming for a high sensitivity or a strong predictive value, A5 was non‐inferior to A10 and actually missed fewer cases needing massive transfusion. A5 has similar utility to both A10 and maximum clot firmness as an early measure of clot firmness, and a low A5 value is strongly predictive of the need for massive transfusion.

show abstract

Section: Discussionmentioning

confidence: 98%

“…We focused on A5, A10 and MCF using the EXTEM assay . We used scatter plots and Spearman correlation coefficients to examine the relationship of A5 and A10 with MCF.…”

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Using rotational thromboelastometry clot firmness at 5 minutes (ROTEM^® EXTEM A5) to predict massive transfusion and in‐hospital mortality in trauma: a retrospective analysis of 1146 patients

et al. 2018

View full text Add to dashboard Cite

show abstract

“…Studies in different but related clinical settings, not included in this systematic review, have also investigated TEG® and ROTEM®. Two studies of ROTEM® in a mixed population with shock [ 66 ] and noncardiac surgery [ 67 ] demonstrated rapid and useful results to guide decisions in hemostatic resuscitation. Other studies with mixed trauma and nontrauma populations [ 68 - 71 ] demonstrated good ability of ROTEM® to predict the need for MT, a clinically useful outcome regardless of management approach (laboratory abnormality-directed versus blood-product ratio based).…”

Section: Discussionmentioning

confidence: 99%

Effect of thromboelastography (TEG®) and rotational thromboelastometry (ROTEM®) on diagnosis of coagulopathy, transfusion guidance and mortality in trauma: descriptive systematic review

et al. 2014

View full text Add to dashboard Cite

IntroductionThe understanding of coagulopathies in trauma has increased interest in thromboelastography (TEG®) and thromboelastometry (ROTEM®), which promptly evaluate the entire clotting process and may guide blood product therapy. Our objective was to review the evidence for their role in diagnosing early coagulopathies, guiding blood transfusion, and reducing mortality in injured patients.MethodsWe considered observational studies and randomized controlled trials (MEDLINE, EMBASE, and Cochrane databases) to February 2014 that examined TEG®/ROTEM® in adult trauma patients. We extracted data on demographics, diagnosis of early coagulopathies, blood transfusion, and mortality. We assessed methodologic quality by using the Newcastle-Ottawa scale (NOS) for observational studies and QUADAS-2 tool for diagnostic accuracy studies.ResultsFifty-five studies (12,489 patients) met inclusion criteria, including 38 prospective cohort studies, 15 retrospective cohort studies, two before-after studies, and no randomized trials. Methodologic quality was moderate (mean NOS score, 6.07; standard deviation, 0.49). With QUADAS-2, only three of 47 studies (6.4%) had a low risk of bias in all domains (patient selection, index test, reference standard and flow and timing); 37 of 47 studies (78.8%) had low concerns regarding applicability. Studies investigated TEG®/ROTEM® for diagnosis of early coagulopathies (n = 40) or for associations with blood-product transfusion (n = 25) or mortality (n = 24). Most (n = 52) were single-center studies. Techniques examined included rapid TEG® (n =12), ROTEM® (n = 18), TEG® (n = 23), or both TEG® and rapid TEG® (n = 2). Many TEG®/ROTEM® measurements were associated with early coagulopathies, including some (hypercoagulability, hyperfibrinolysis, platelet dysfunction) not assessed by routine screening coagulation tests. Standard measures of diagnostic accuracy were inconsistently reported. Many abnormalities predicted the need for massive transfusion and death, but predictive performance was not consistently superior to routine tests. One observational study suggested that a ROTEM®-based transfusion algorithm reduced blood-product transfusion, but TEG®/ROTEM®-based resuscitation was not associated with lower mortality in most studies.ConclusionsLimited evidence from observational data suggest that TEG®/ROTEM® tests diagnose early trauma coagulopathy and may predict blood-product transfusion and mortality in trauma. Effects on blood-product transfusion, mortality, and other patient-important outcomes remain unproven in randomized trials.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-014-0518-9) contains supplementary material, which is available to authorized users.

show abstract

“…Rotational thromboelastometry assay diagnostics utilize citrated whole blood with four independent measuring channels to allow a combination of appropriate assays . The EXTEM assay detects deficiencies of vitamin K‐dependent coagulation factors, fibrinogen, platelets and factor XIII.…”

Section: Methodsmentioning

confidence: 99%

Protocol guided bleeding management improves cardiac surgery patient outcomes

et al. 2015

View full text Add to dashboard Cite

show abstract

Rotational thrombolelastometry produces potentially clinical useful results within 10 min in bleeding Emergency Department patients

Cited by 15 publications

References 12 publications

Using rotational thromboelastometry clot firmness at 5 minutes (ROTEM^® EXTEM A5) to predict massive transfusion and in‐hospital mortality in trauma: a retrospective analysis of 1146 patients

Using rotational thromboelastometry clot firmness at 5 minutes (ROTEM^® EXTEM A5) to predict massive transfusion and in‐hospital mortality in trauma: a retrospective analysis of 1146 patients

Effect of thromboelastography (TEG®) and rotational thromboelastometry (ROTEM®) on diagnosis of coagulopathy, transfusion guidance and mortality in trauma: descriptive systematic review

Protocol guided bleeding management improves cardiac surgery patient outcomes

Contact Info

Product

Resources

About

Rotational thrombolelastometry produces potentially clinical useful results within 10 min in bleeding Emergency Department patients

Cited by 15 publications

References 12 publications

Using rotational thromboelastometry clot firmness at 5 minutes (ROTEM® EXTEM A5) to predict massive transfusion and in‐hospital mortality in trauma: a retrospective analysis of 1146 patients

Using rotational thromboelastometry clot firmness at 5 minutes (ROTEM® EXTEM A5) to predict massive transfusion and in‐hospital mortality in trauma: a retrospective analysis of 1146 patients

Effect of thromboelastography (TEG®) and rotational thromboelastometry (ROTEM®) on diagnosis of coagulopathy, transfusion guidance and mortality in trauma: descriptive systematic review

Protocol guided bleeding management improves cardiac surgery patient outcomes

Contact Info

Product

Resources

About

Using rotational thromboelastometry clot firmness at 5 minutes (ROTEM^® EXTEM A5) to predict massive transfusion and in‐hospital mortality in trauma: a retrospective analysis of 1146 patients

Using rotational thromboelastometry clot firmness at 5 minutes (ROTEM^® EXTEM A5) to predict massive transfusion and in‐hospital mortality in trauma: a retrospective analysis of 1146 patients