Viscoelastic monitoring in trauma resuscitation

Abstract

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.

Viscoelastic Monitoring in Liver Transplantation

“…( 37 ) A narrative review of the application of VEM in trauma‐related coagulopathy and massive bleeding showed that VEM assays appear to be particularly adept in differentiating injury‐related fibrinolysis phenotypes earlier in the course and help direct appropriate treatment. ( 38 )…”

Impact of general anesthesia on rotational thromboelastometry (ROTEM) parameters and standard plasmatic coagulation tests in healthy Beagle dogs

“…Thromboelastometry parameters in people after sevoflurane or propofol anesthesia were not different to preanesthetic measurements ( Koo et al., 2014 ) . However, the effect of intra-anesthetic assessment of coagulation parameters has never been studied in people despite the widespread use of viscoelastic tests during anesthesia for trauma-related, cardiac and transplantation surgery ( Agarwal & Abdelmotieleb, 2020 ; Sayce, Neal & Leeper, 2020 ). To the authors’ knowledge in dogs neither intra- nor postanesthetic measurements were compared to preanesthetic measurements.…”

Viscoelastic Testing and Coagulopathy of Traumatic Brain Injury

“…ROTEM ® also has its own platelet functionality testing called PLTEM, which has not been studied in TBI and is rarely used in the setting of polytrauma [113][114][115]. In PLTEM, the A10 parameter represents the amplitude of the tracing 10 min after the end of CT. PLTEM calculates the difference between the EXTEM A10 (A10 EX ) and the FIBTEM A10 (A10 FIB ).…”