Thromboelastometric (ROTEM) Findings in Patients Suffering from Isolated Severe Traumatic Brain Injury

Schöchl, Herbert; Solomon, Cristina; Traintinger, Stefan; Nienaber, Ulrike; Tacacs-Tolnai, Astrid; Windhofer, Christian; Bahrami, Soheyl; Voelckel, Wolfgang G.

doi:10.1089/neu.2010.1744

Cited by 117 publications

(99 citation statements)

References 41 publications

(39 reference statements)

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“…end-concentration of wine, remained unchanged with simultaneous delay in clot formation. This finding is in accordance with previous studies [3,4], and clinically important, since the present guidelines regarding the treatment of traumatic coagulopathy are based on viscoelastic determination of clot strength. However, an attempt to counteract the particular effect of alcohol on clot formation may not be indicated since the developing clot representing combined function of extrinsic coagulation pathway and platelets (EXTEM), will be finally firm enough.…”

Section: Discussionsupporting

confidence: 92%

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Alcohol induces profuse reversible decrease in platelet function and delayed initiation of co-agulation

Schramko¹,

Niemi²

2014

Emerg Med Health Care

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Moderate alcohol consumption may influence platelet aggregation, reduce fibrinogen concentration or increase clot dissolution. Since the binge-drinking pattern observed among some Northern people leads to exposure of traumatic brain injury and the immediate effects of alcohol on platelet function and whole blood coagulation are partly unknown, we performed an experiment aiming to characterize coagulation capacity during substantial intake of alcohol. A 49-year old volunteer man drank 1 bottle of sparkling wine within one hour: during the first 15 minutes-0.24 L, during the next 15 minutes-0.24 L more, and finally the rest of bottle (0.27 L) within 30 minutes. Rotational thromboelastometry and platelet function analysis have been performed. Platelet aggregation decreased at 30 minutes, but at 60 minutes the aggregation exceeded the 0 minutes values. Maximum clot firmness remained stable, but clot formation time was prolonged at 30 and 60 minutes. Fibrinolysis has been increased at 30 and 60 minutes. A momentary disturbance of platelet function followed by hyperaggregation, delayed initiation of coagulation and increase in fibrin clot lysis are seen during the early phase of alcohol intake. Since the effects of alcohol may be individual, a combination of detailed history of drinking and point of care evaluation of coagulation and platelet function may shed light on various treatment options in trauma patients on alcohol.

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Section: Discussionsupporting

confidence: 92%

“…Traumatic hypocoagulopathy is defined by decrease in clot strength [3]. Interestingly, in the current study the clot strength of the volunteer, and also in vitro with the 15% vol.…”

Section: Discussionmentioning

confidence: 48%

Alcohol induces profuse reversible decrease in platelet function and delayed initiation of co-agulation

Schramko¹,

Niemi²

2014

Emerg Med Health Care

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“…Coagulopathy is a common occurrence following brain damage 10 and requires immediate and aggressive management to avoid anaemia, which could lead to secondary brain insult. Patients in the ICU are transfused with blood when their haemoglobin level is lower than 10 g/dl.…”

Section: Discussionmentioning

confidence: 99%

Outcome of traumatic brain injury in the intensive care unit: a five-year review

Tobi

Azeez

Agbedia

2016

Southern African Journal of Anaesthesia and Analgesia

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Introduction: Traumatic brain injury (TBI) is a major challenge in the intensive care unit (ICU) with a high mortality. In a recent study, severe TBI accounted for 14.3% of all ICU admissions with a mortality of 54.0%. Methodology: This was a retrospective, case-control study of all cases of TBI admitted into the ICU during the study period. Data retrieved included socio-demographic parameters, causes of TBI, blood transfusion, length of stay and ICU outcome in terms of mortality. Result: One hundred and eighty-two (182) TBI patients were admitted into the ICU, with a mean age of 34 ± 18.92 years. The male:female ratio was 3:1, but females had a better outcome with a p-value of 0.026. Patients who stayed between 1 and 7 days were > 4 times more likely to die in the ICU compared with those who stayed for more than 7 days. In addition, TBI patients who had blood transfusion had a better outcome (p = 0.004). Also, TBI patients who received ventilatory support had higher mortality compared with those who did no, (p = 0.006). Conclusion:Patients with traumatic brain injury admitted to the intensive care unit have a high mortality. A review of the present line of management and strict compliance with guidelines of management may perhaps improve outcome.

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“…Ähnlich der konventionellen Gerinnungsanalytik bleiben exakte Grenzwerte jedoch schwer fassbar, da in der gegenwärtigen Literatur OutcomeDaten häufig mit willkürlich gesetzten Grenzwerten erhoben wurden und bislang keine strengen Grenzwertanalysen durchgeführt wurden. In einer prospekti- Insbesondere bei Patienten mit isoliertem Schädel-Hirn-Trauma (SHT) ist die FIB-TEM-MCF signifikant mit der Mortalität assoziiert [80]. In retrospektiven Arbeiten zeigten sich für das TEG® eine geringe Gerinnselfestigkeit (MA < 50 mm) sowie der daraus abgeleitete G-Wert (Gerinnselelastizität) als unabhängige Risikofaktoren für die Mortalität [63,67].…”

Section: Internationale Konsensuskonferenz In Philadelphiaunclassified

Frühe viskoelastizitätsbasierte Gerinnungstherapie bei blutenden Schwerverletzten

et al. 2015

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Although there is increasing interest in the use of a viscoelastic test procedure (ROTEM/TEG) for diagnostics and therapy guidance of severely injured and bleeding patients, currently no uniformly accepted guidelines exist for how this technology should be integrated into clinical treatment. In September 2014 an international multidisciplinary group of opinion leaders in the field of trauma-induced coagulopathy and other disciplines involved in the treatment of severely injured patients were assembled for a 2-day consensus conference in Philadelphia (USA). This panel included trauma/accident surgeons, general/abdominal surgeons, vascular surgeons, emergency/intensive care surgeons, hematologists, transfusion specialists, anesthesiologists, laboratory physicians, pathobiologists/pathophysiologists and the lay public. A total of nine questions regarding the impact of viscoelastic testing in the early treatment of trauma patients were developed prior to the conference by a panel consensus. Early use was defined as baseline viscoelastic test result thresholds obtained within the first minutes of hospital arrival, when conventional laboratory results are not yet available. The available data for each question were then reviewed in person using standardized presentations by the expert panel. A consensus summary document was then developed and reviewed by the panel in an open forum. Finally, a 2-round Delphi poll was administered to the panel of experts regarding viscoelastic thresholds for triggering the initiation of specific treatments including fibrinogen (concentrates), platelet concentrates, blood plasma products and prothrombin complex concentrates (PCC). This report summarizes the findings and recommendations of this consensus conference, which correspond to a S2k guideline according to the system of the Association of the Scientific Medical Societies in Germany (AWMF) and taking formal consensus findings including Delphi methods into consideration.

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Thromboelastometric (ROTEM) Findings in Patients Suffering from Isolated Severe Traumatic Brain Injury

Cited by 117 publications

References 41 publications

Alcohol induces profuse reversible decrease in platelet function and delayed initiation of co-agulation

Alcohol induces profuse reversible decrease in platelet function and delayed initiation of co-agulation

Outcome of traumatic brain injury in the intensive care unit: a five-year review

Frühe viskoelastizitätsbasierte Gerinnungstherapie bei blutenden Schwerverletzten

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