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The Role of TEG and ROTEM in Damage Control Resuscitation

Department of Surgery, University of Texas Health Science Center, Houston, Texas. Department of Surgery, University of California Riverside, Riverside, California. Division Chief Acute Care Surgery, Department of Surgery Tulane, New Orleans, Louisiana. VCU Surgery Trauma, Critical Care and Emergency Surgery, Richmond, Virginia. Department of Cardiothoracic and Vascular Surgery, Faculty of Life Science Örebro University Hospital and University, Örebro, Sweden. Vascular Surgery Service, San Antonio Military Medical Center, San Antonio, Texas. Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, UK. Regional Trauma Services Foothills Medical Centre, Calgary, Alberta, Canada. Departments of Surgery, Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada. Canadian Forces Health Services, Calgary, Alberta, Canada. Fundación Valle del Lili, Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Valle, Colombia. Department of Surgery and Surgical Critical Care, University of Campinas, Campinas, Brazil. Department of Cardiothoracic and Vascular Surgery, Linköping University Hospital, Linköping, Sweden.

Shock (Augusta, Ga.). 2021;56(1s):52-61
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Abstract
Trauma-induced coagulopathy is associated with very high mortality, and hemorrhage remains the leading preventable cause of death after injury. Directed methods to combat coagulopathy and attain hemostasis are needed. The available literature regarding viscoelastic testing, including thrombelastography (TEG) and rotational thromboelastometry (ROTEM), was reviewed to provide clinically relevant guidance for emergency resuscitation. These tests predict massive transfusion and developing coagulopathy earlier than conventional coagulation testing, within 15 min using rapid testing. They can guide resuscitation after trauma, as well. TEG and ROTEM direct early transfusion of fresh frozen plasma when clinical gestalt has not activated a massive transfusion protocol. Reaction time and clotting time via these tests can also detect clinically significant levels of direct oral anticoagulants. Slowed clot kinetics suggest the need for transfusion of fibrinogen via concentrates or cryoprecipitate. Lowered clot strength can be corrected with platelets and fibrinogen. Finally, viscoelastic tests identify fibrinolysis, a finding associated with significantly increased mortality yet one that no conventional coagulation test can reliably detect. Using these parameters, guided resuscitation begins within minutes of a patient's arrival. A growing body of evidence suggests this approach may improve survival while reducing volumes of blood products transfused.
Study details
Study Design : Systematic Review
Language : eng
Credits : Bibliographic data from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine