Traumatic Abdominal Solid Organ Injury Patients Might Benefit From Thromboelastography-Guided Blood Component Therapy

Wang, Hao; Robinson, Richard D.; Phillips, Jessica; Ryon, Andrew; Simpson, Scott D.; Ford, Jonathan R.; Umejiego, Johnbosco; Duane, Therèse M.; Putty, Bradley; Zenarosa, Nestor R.

doi:10.14740/jocmr3005w

Cited by 10 publications

(14 citation statements)

References 26 publications

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“…Although CCTs patients needed a similar number of red blood cell units as TEG patients, patients in the CCTs group received more FFP and platelets units in the first 2 hours of resuscitation. 30 In the last study, Wang et al 37 reported a significant difference between the intervention and control groups for all the endpoints studied (red blood cells, 4±7 vs 9±10 units, P<0.01; platelets, 0.4±1.5 vs 2.9±4.8 units, P<0.01; FFP, 1±5 vs 5±6 units, P<0.01; ICU LOS 8.8±10.6 vs 13.6±14 days, P<0.05; hospital LOS 14±12 vs 19±1 days, P< 0.005).…”

Section: Resultsmentioning

confidence: 97%

“…The characteristics of the 6 studies are summarized in Table 1. [30][31][32][33]36,37 A random-effects model (DerSimonia-Laird method) or a fixed-effects model (Mantel-Haenszel method) were then applied when significant (I 2 ≥50% and P<0.1) or insignificant heterogeneity could be calculated. Heterogeneity was tested by estimating the proportion of between-study inconsistencies due to actual differences among studies rather than differences due to random error or chance, using the I 2 statistic.…”

Section: Methods Of Researchmentioning

confidence: 99%

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Trauma-induced coagulopathy. A narrative review of goal-directed hemostatic resuscitation

Pigna¹,

Lippi

Saronni

et al. 2018

Emerg Care J

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Post-traumatic haemorrhage is the leading cause of death in trauma patients. The development of coagulopathy substantially contributes to bleeding severity and to the ensuing unfavourable outcome. Trauma-induced coagulopathy (TIC) can be seen in 10-25% of patients with major trauma, and its early and appropriate therapeutic management leads to considerable reduction of mortality risk. Due to the extreme complexity of TIC pathophysiology, the limitations of conventional coagulation tests (CCTs) have become evident in recent years. Unlike these routine tests, point of care viscoelastic tests (VET) such as thromboelastogram (TEG) or rotational thromboelastography (ROTEM) provide valuable clinical information by real time assessment of changes in viscoelastic properties of blood throughout clot formation. This review was aimed to collect and discuss available evidence on goal-directed hemostatic resuscitation, based on TEG or ROTEM data. We included studies with patients aged 18 years or older, major trauma, and needing massive transfusions. Overall, 6 studies totalling 1533 patients were finally included. A total number of 288 patients died, 98 of whom in the TEG- or ROTEM-guided cohorts (i.e., intervention groups). A 36% reduction of death was observed in the intervention groups (relative risk, 0.641; 95% CI 0.517-0.795; P<0.001). Our results show that VET-guided management is effective to reduce mortality compared to conventional management with CCTs. Except for mortality, all others endpoints were heterogeneous across the studies. This emphasize the need of scheduling new and well-designed trials, aimed to better define the optimal strategy for TIC management.

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Section: Resultsmentioning

confidence: 97%

Section: Methods Of Researchmentioning

confidence: 99%

Trauma-induced coagulopathy. A narrative review of goal-directed hemostatic resuscitation

Pigna¹,

Lippi

Saronni

et al. 2018

Emerg Care J

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“…These changes are likely dependent upon local practice as other studies have demonstrated increased blood product administration 133 ; however, standardization of thresholds 86,87 may alter these findings. Cost‐effectiveness 190 and shorter length of stay 191 have also been demonstrated.…”

Section: Resultsmentioning

confidence: 99%

Viscoelastic monitoring in trauma resuscitation

2020

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BackgroundTraumatic injury results in both physical and physiologic insult. Successful care of the trauma patient depends upon timely correction of both physical and biochemical injury. Trauma‐induced coagulopathy is a derangement of hemostasis and thrombosis that develops rapidly and can be fatal if not corrected. Viscoelastic monitoring (VEM) assays have been developed to provide rapid, accurate, and relatively comprehensive depictions of an individual's coagulation profile. VEM are increasingly being integrated into trauma resuscitation guidelines to provide dynamic and individualized guidance to correct coagulopathy.Study Design and MethodsWe performed a narrative review of the search terms viscoelastic, thromboelastography, thromboelastometry, TEG, ROTEM, trauma, injury, resuscitation, and coagulopathy using PubMed. Particular focus was directed to articles describing algorithms for management of traumatic coagulopathy based on VEM assay parameters.ResultsOur search identified 16 papers with VEM‐guided resuscitation strategies in adult patients based on TEG, 12 such protocols in adults based on ROTEM, 1 protocol for children based on TEG, and 2 protocols for children based on ROTEM.ConclusionsThis review presents evidence to support VEM use to detect traumatic coagulopathy, discusses the role of VEM in trauma resuscitation, provides a summary of proposed treatment algorithms, and discusses pending questions in the field.

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“…2 ). Among the eight observational studies, seven were before-after comparisons [ 20 – 22 , 24 – 27 ], and one was a retrospective analysis [ 23 ]. The participants in these studies were all civilian trauma patients.…”

Section: Resultsmentioning

confidence: 99%

“… Data in studies of Cochrane [ 20 ], Campbell [ 21 ], and Wang [ 23 ] were expressed as mean ± standard deviation; data in studies of Mohamed [ 24 ] were expressed as mean; data in studies of Baksaas-Aasen [ 29 ], Unruh [ 22 ], Gonzalez [ 28 ], and Yin [ 25 ] were expressed as median (interquartile range). If there were data in several phases after injury, only the data in 24 h after admission/injury were recorded VHA viscoelastic hemostatic assay; TEG thrombelastography; ROTEM rotational thromboelastometry; MTP massive transfusion protocol; ISS injury severity score; RBCs red blood cells; MOI mechanism of injury; ITT: intent-to-treat *** P < 0.001 compared with VHA group, ** P < 0.01 compared with VHA group, * P < 0.05 compared with VHA group a fresh-frozen plasma/octaplasma b one pool = four individual platelet units c fibrinogen equivalent d cryoprecipitate e fibrinogen concentrate, –: not reported …”

Section: Resultsmentioning

confidence: 99%

Utility of viscoelastic hemostatic assay to guide hemostatic resuscitation in trauma patients: a systematic review

Zhu

Hong

et al. 2022

World J Emerg Surg

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Objective Viscoelastic hemostatic assay (VHA) provides a graphical representation of a clot’s lifespan and reflects the real time of coagulation. It has been used to guide trauma resuscitation; however, evidence of the effectiveness of VHAs is still limited. This systematic review aims to summarize the published evidence to evaluate the VHA-guided strategy in resuscitating trauma patients. Methods The PubMed, Embase, and Web of Science databases were searched from their inception to December 13, 2021. Randomized controlled trials (RCTs) or observational studies comparing VHA-guided transfusion to controls in resuscitating trauma patients were included in this systematic review. Results Of the 7743 records screened, ten studies, including two RCTs and eight observational studies, met the inclusion criteria. There was great heterogeneity concerning study design, enrollment criterion, VHA device, VHA-guided strategy, and control strategy. Thrombelastography (TEG) was used as a guiding tool for transfusion in eight studies, and rotational thromboelastometry (ROTEM), and TEG or ROTEM were used in the other two studies. The overall risk of bias assessment was severe or mild in RCTs and was severe or moderate in observational studies. The main outcomes reported from the included studies were blood transfusion (n = 10), mortality (n = 10), hospital length of stay (LOS) (n = 7), intensive care unit LOS (n = 7), and cost (n = 4). The effect of the VHA-guided strategy was not always superior to the control. Most of the studies did not find significant differences in the transfusion amount of red blood cells (n = 7), plasma (n = 5), platelet (n = 7), cryoprecipitate/fibrinogen (n = 7), and mortality (n = 8) between the VHA-guided group and control group. Notable, two RCTs showed that the VHA-guided strategy was superior or equal to the conventional coagulation test-guided strategy in reducing mortality, respectively. Conclusion Although some studies demonstrated VHA-guided strategy probable benefit in reducing the need for blood transfusion and mortality when resuscitating trauma patients, the evidence is still not robust. The quality of evidence was primarily downgraded by the limited number of included studies and great heterogeneity and severe risk of bias in these. Further studies are strongly recommended.

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Traumatic Abdominal Solid Organ Injury Patients Might Benefit From Thromboelastography-Guided Blood Component Therapy

Cited by 10 publications

References 26 publications

Trauma-induced coagulopathy. A narrative review of goal-directed hemostatic resuscitation

Trauma-induced coagulopathy. A narrative review of goal-directed hemostatic resuscitation

Viscoelastic monitoring in trauma resuscitation

Utility of viscoelastic hemostatic assay to guide hemostatic resuscitation in trauma patients: a systematic review

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