TEG-guided resuscitation is superior to standardized MTP resuscitation in massively transfused penetrating trauma patients

Tapia, Nicole M.; Chang, Alex L.; Norman, Michael; Welsh, Francis J.; Scott, Bradford G.; Wall, Matthew J.; Mattox, Kenneth L.; Suliburk, James W.

doi:10.1097/ta.0b013e31827e20e0

Cited by 174 publications

(133 citation statements)

References 37 publications

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“…Thereafter, interests developed for using viscoelastic test guided transfusion algorithms in cardiovascular surgery and trauma [17]. Tapia et al demonstrated that TEG-guided resuscitation was superior to standard MTP in patients with penetrating injury that received more than 10 units of blood [14]. The study by Tauber et al further adds to the evidence that rotational thromboelastometry assays are useful in managing trauma patients [18].…”

Section: Discussionmentioning

confidence: 74%

Impact of Early Thromboelastography-Directed Therapy in Trauma Resuscitation

Salib

Mohamed

Majeske

et al. 2017

Journal of the American College of Surgeons

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Background: Conventional coagulation tests do not provide an accurate representation of the complex nature of trauma induced coagulopathy. Thrombelastography provides a prompt global overview of all dynamic sequential aspects of trauma induced coagulopathy. The objective of this study was to evaluate the impact of using thrombelastography on blood products utilization, crystalloids utilization, hospital, and intensive care using length of stay, and cost savings.

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Section: Discussionmentioning

confidence: 74%

Impact of Early Thromboelastography-Directed Therapy in Trauma Resuscitation

Salib

Mohamed

Majeske

et al. 2017

Journal of the American College of Surgeons

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“…It has been extensively used in hepatic and cardiac surgery to guide resuscitation and has been shown in blunt trauma to be associated with specifi c transfusion requirements [ 85 ]. Tapia et al compared TEG directed resuscitation with MTP resuscitation in patients receiving massive transfusions as they are coagulopathic and even with aggressive resuscitation only 65 % of coagulation factor activity is delivered [ 86 ]. TEG directed therapy was found to be superior to MTP in both blunt and penetrating injury.…”

Section: Laboratory Assessment Of Coagulopathy During Mtmentioning

confidence: 98%

Massive Transfusion Protocols

Moren

Underwood

Schreiber

2016

Trauma Induced Coagulopathy

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“…Bedside thromboelastography (TEG) is being used increasingly during damage control resuscitation to titrate blood component transfusion with favorable results [115]. Previously it was thought that fibrinolysis is unlikely after trauma.…”

Section: Damage Control Resuscitationmentioning

confidence: 99%

Thoracic and Abdominal Injuries

Capan

Miller

2014

Anesthesia for Trauma

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Injuries to the thorax and the abdomen-the torso-contribute significantly to trauma-related mortality and morbidity. While the vulnerability of the closely organized vital organs to injury in this region plays an important role in morbidity and mortality, the noncompressible nature of hemorrhage in this area also contributes immensely to otherwise preventable trauma deaths. While it is estimated that one fourth of trauma deaths is secondary to chest trauma alone and claims about 16,000 lives per year [1], hemorrhage in the torso (thorax, abdomen, and pelvis) also results in a mortality of as much as 70-80 % after otherwise survivable noncerebral and noncardiac injuries in both civilian and military populations [2]. The overall mortality from exsanguination, which remains second to central nervous system (CNS) injury as a cause of death, primarily originates from injuries of the thorax, abdomen, and pelvis; there has been a reduction in death from extremity bleeding because of effective control with tourniquets or topical hemostatic agents, but not from torso bleeding. With increasing use of anticoagulant agents for prophylaxis and management of cardio-and cerebrovascular disorders, bleedingrelated mortality from truncal injuries is probably more frequent. For example, the predominant injury site in patients with cardiovascular disease who died after trauma in one study was chest in 15 % and abdomen in 3 % of instances; head and neck was the injury site in 69 % of patients [3].In 2008, of the more than 42 million injuryrelated emergency room visits in the United States only 4 % were due to torso injuries; the corresponding percentages for upper extremity injuries, lower extremity injuries, head and neck injuries, and vertebral injuries were 18 %, 15 %, 14 %, and 5 %, respectively [4]. Other diagnoses such as poisoning, adverse effects, ill-defined conditions, and mental disorders made up the remaining injury-related emergency room admissions [4]. Thus, although torso injuries represent a relatively small percentage of the emergency room load, they appear to cause a greater proportion of morbidity and mortality than other injuries.Up to 80 % of thoracic injuries coexist with other injuries in major trauma patients, but they require major surgery and anesthesia relatively infrequently. Yet undetected, relatively minor thoracic injuries may result in life-threatening events during surgery for associated injuries or intensive care management of the multiple trauma patient. Pneumothorax and hemothorax are perfect examples of this clinical situation. On the other hand, because of their sometimes silent nature, even major thoracic injuries (e.g., esophageal, diaphragmatic, and airway trauma) may be missed if appropriate diagnostic

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TEG-guided resuscitation is superior to standardized MTP resuscitation in massively transfused penetrating trauma patients

Abstract: Therapeutic study, level IV.

Cited by 174 publications

References 37 publications

Impact of Early Thromboelastography-Directed Therapy in Trauma Resuscitation

Impact of Early Thromboelastography-Directed Therapy in Trauma Resuscitation

Massive Transfusion Protocols

Thoracic and Abdominal Injuries

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