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Towards patient‐specific management of trauma hemorrhage: the effect of resuscitation therapy on parameters of thromboelastometry
Author(s): ,
Nicole P. Juffermans
Affiliations:
Department of Intensive Care Medicine, Amsterdam UMC, Academic Medical Center, Amsterdam, the Netherlands
Correspondence: Nicole Juffermans, Department of Intensive Care, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands|Tel.: +31 20 566 8090|E‐mail: n.p.juffermans@amc.uva.nl
,
Mathijs R. Wirtz
Affiliations:
Department of Intensive Care Medicine, Amsterdam UMC, Academic Medical Center, Amsterdam, the Netherlands
,
Kirsten Balvers
Affiliations:
Department of Intensive Care Medicine, Amsterdam UMC, Academic Medical Center, Amsterdam, the Netherlands. Trauma Unit, Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands
,
Kjersti Baksaas‐Aasen
Affiliations:
Department of Traumatology, Oslo University Hospital, Oslo, Norway. Department of Anesthesiology, Oslo University Hospital, Oslo, Norway
,
Susan Dieren
Affiliations:
Department of Intensive Care Medicine, Amsterdam UMC, Academic Medical Center, Amsterdam, the Netherlands
,
Christine Gaarder
Affiliations:
Department of Traumatology, Oslo University Hospital, Oslo, Norway
,
Paul A. Naess
Affiliations:
Department of Traumatology, Oslo University Hospital, Oslo, Norway
,
Simon Stanworth
Affiliations:
NHS Blood and Transplant/Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Oxford, UK. Radcliffe Department of Medicine, University of Oxford, Oxford, UK
,
Pär I. Johansson
Affiliations:
Department of Anesthesiology and Trauma Center, Center for Head and Orthopedics, and Section for Transfusion Medicine, Capital Region Blood Bank, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
,
Jakob Stensballe
Affiliations:
Department of Anesthesiology and Trauma Center, Center for Head and Orthopedics, and Section for Transfusion Medicine, Capital Region Blood Bank, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
,
Marc Maegele
Affiliations:
Department for Traumatology and Orthopedic Surgery, Cologne‐Merheim Medical Center, University of Witten/Herdecke, Cologne, Germany
,
J. C. Goslings
Affiliations:
Trauma Unit, Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands
,
Karim Brohi
Affiliations:
Trauma Sciences, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK

Affiliations:
ISTH Academy. Juffermans N.
Mar 1, 2019; 273395
Nicole Juffermans
Nicole Juffermans
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Journal Abstract
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Background
Rotational thromboelastometry (ROTEM) can detect trauma‐induced coagulopathy (TIC) and is used in transfusion algorithms. The response of ROTEM to transfusion therapy is unknown.
Objectives
To determine the response of ROTEM profiles to therapy in bleeding trauma patients.
Patients/Methods
A prospective multicenter study in bleeding trauma patients (receiving ≥ 4 red blood cell [RBC] units) was performed. Blood was drawn in the emergency department, after administration of 4, 8 and 12 RBC units and 24 h post‐injury. The response of ROTEM to plasma, platelets (PLTs), tranexamic acid (TXA) and fibrinogen products was evaluated in the whole cohort as well as in the subgroup of patients with ROTEM values indicative of TIC.
Results
Three hundred and nine bleeding and shocked patients were included. A mean dose of 3.8 g of fibrinogen increased FIBTEM CA5 by 5.2 mm (IQR: 4.1–6.3 mm). TXA administration decreased lysis by 5.4% (4.3–6.5%). PLT transfusion prevented further derangement of parameters of clot formation. The effect of PLTs on EXTEM ca5 values was more pronounced in patients with a ROTEM value indicative of TIC than in the whole cohort. Plasma transfusion decreased EXTEM clotting time by 3.1 s (− 10 s to 3.9 s) in the whole cohort and by 10.6 s (− 45 s to 24 s) in the subgroup of patients with a ROTEM value indicative of TIC.
Conclusion
The effects of therapy on ROTEM values were small, but prevented further derangement of test results. In patients with ROTEM values indicative of TIC, the efficacy of PLTs and plasma in correcting deranged ROTEM parameters is possibly more robust.
Keyword(s)
hemorrhage, ROTEM , transfusion, trauma, viscoelastic hemostatic assay
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