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Text
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<a href="http://doi.org/10.1097/ta.0000000000002944" target="_blank" rel="noreferrer noopener">http://doi.org/10.1097/ta.0000000000002944</a>
ISSN
2163-0763 2163-0755
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Update Year & Number
Hospital List
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Title
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Thromboelastography and Rotational Thromboelastometry in Bleeding Patients with Coagulopathy: Practice Management Guideline from the Eastern Association for the Surgery of Trauma.
Publisher
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The Journal of Trauma and Acute Care Surgery
Date
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2020
2020-09-16
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Bugaev N; Como JJ; Golani G; Freeman JJ; Sawhney JS; Vatsaas CJ; Yorkgitis BK; Kreiner LA; Garcia NM; Aziz Hiba A; Pappas PA; Mahoney EJ; Brown ZW; Kasotakis G
Description
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BACKGROUND: Assessment of the immediate need for specific blood product transfusions in acutely bleeding patients is challenging. Clinical assessment and commonly used coagulation tests are inaccurate and time-consuming. The goal of this practice management guideline was to evaluate the role of the viscoelasticity tests: thromboelastography (TEG) and rotational thromboelastometry (ROTEM), in the management of acutely bleeding trauma, surgical and critically ill patients. METHODS: Systematic review and meta-analyses of manuscripts comparing TEG/ROTEM to non-TEG/ROTEM-guided blood products transfusions strategies were performed. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was applied to assess the level of evidence and create recommendations for TEG/ROTEM-guided blood product transfusions in adult trauma, surgical, and critically ill patients. RESULTS: Utilizing TEG/ROTEM-guided blood transfusions in acutely bleeding trauma, surgical, and critically ill patients was associated with a tendency to fewer blood product transfusions in all populations. TEG/ROTEM-guided transfusions were associated with a reduced number of additional invasive hemostatic interventions (angioembolic, endoscopic, or surgical) in surgical patients. TEG/ROTEM -guided transfusions were associated with a reduction in mortality in trauma patients. CONCLUSION: In patients with ongoing hemorrhage and concern for coagulopathy, we conditionally recommend using TEG/ROTEM-guided transfusions, compared with traditional coagulation parameters, to guide blood component transfusions in each of the following three groups: adult trauma patients, adult surgical patients, and patients with critical illness. LEVEL OF EVIDENCE: Level II TYPE OF STUDY: Therapeutic.
Identifier
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<a href="http://doi.org/10.1097/ta.0000000000002944" target="_blank" rel="noreferrer noopener">10.1097/ta.0000000000002944</a>
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journalArticle
2020
Aziz Hiba A
Brown ZW
Bugaev N
Como JJ
Freeman JJ
Garcia NM
Golani G
Hospital List
journalArticle
Kasotakis G
Kreiner LA
Mahoney EJ
Pappas PA
Sawhney JS
The journal of trauma and acute care surgery
Vatsaas CJ
Yorkgitis BK