Thromboelastography in Orthopaedic Trauma Acute Pelvic Fracture Resuscitation: A Descriptive Pilot Study. Issue 6 (June 2016)

• Record Type: Journal Article
• Authors: Mamczak, Christiaan N.; Maloney, Megan; Fritz, Braxton; Boyer, Bryan; Thomas, Scott; Evans, Ed; Ploplis, Victoria A.; Castellino, Francis J.; McCollester, Jonathon; Walsh, Mark
• Is Part Of: Journal of orthopaedic trauma. Volume 30:Issue 6(2016)
• Publication Date: 2016-06
• Subjects: thromboelastography -- TEG -- platelet mapping -- trauma-induced coagulopathy -- massive transfusion protocol -- pelvic fracture -- acetabular fracture -- polytrauma; Orthopedics -- Periodicals; Wounds and injuries -- Periodicals; Orthopedics -- Periodicals; Wounds and Injuries -- therapy -- Periodicals; Periodicals; 617.47044
• DOI: 10.1097/BOT.0000000000000537
• Languages: English
• ISSNs: 0890-5339

Abstract

Abstract : Objectives: To describe the adjunctive use of thromboelastography (TEG) in directing initial blood component therapy resuscitation of patients with polytrauma with acute pelvic/acetabular fractures. Design: Retrospective cohort review. Setting: Level-2 trauma center. Patients: Forty adult trauma activations with acute pelvic and/or acetabular fractures were treated with standard fracture care and TEG with adjuvant platelet mapping (TEG/PM) analysis to guide their initial 24-hour resuscitation. Intervention: TEG with PM provided goal-directed hemostatic resuscitation using component blood products and an established hospital transfusion protocol. Transfusions were triggered by abnormal TEG/PM results and/or the presence of active hemorrhage, persistent hemorrhagic shock, and abnormal base deficit levels. Main Outcome Measurement: The correction of trauma-induced coagulopathy was determined by the return of a normal TEG/PM tracing. The numbers of component blood products transfused in the first 24 hours using TEG/PM were calculated. Subgroup analysis of transfusion requirements and differences between pelvic ring and acetabular fracture patterns were determined. Results: More than 90% of patients received a transfusion of at least 1 blood product with 84% of transfusions occurring within 6 hours of admission. TEG/PM-guided resuscitation yielded greater volumes of platelets and packed red blood cells (PRBCs) versus fresh frozen plasma (FFP) ( P = 0.018) with an average transfusion ratio of 2.5:1:2.8 (PRBC:FFP:platelet). There was a trend toward greater transfusion requirements in combined injuries versus pelvic ring or acetabular fractures ( P = 0.08). Conclusion: TEG with PM is a valuable adjunct to guide the acute phase of resuscitation in patients with polytrauma with pelvic injuries because it allows a real-time assessment of the coagulation status. The routine use of TEG/PM may result in transfusion ratios of blood products different from those of the current empiric 1:1:1 guidelines. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence. Abstract : Supplemental Digital Content is Available in the Text.