Data-driven Development of ROTEM and TEG Algorithms for the Management of Trauma Hemorrhage: A Prospective Observational Multicenter Study. Issue 6 (December 2019)

• Record Type: Journal Article
• Authors: Baksaas-Aasen, Kjersti; Van Dieren, Susan; Balvers, Kirsten; Juffermans, Nicole P.; Næss, Pål A.; Rourke, Claire; Eaglestone, Simon; Ostrowski, Sisse R.; Stensballe, Jakob; Stanworth, Simon; Maegele, Marc; Goslings, J. C.; Johansson, Pär I.; Brohi, Karim; Gaarder, Christine
• Is Part Of: Annals of surgery. Volume 270:Issue 6(2019)
• Publication Date: 2019-12
• Subjects: algorithms -- ROTEM -- TEG -- trauma hemorrhage -- trauma induced coagulopathy -- viscoelastic haemostatic assays; Surgery -- Periodicals; 617.005
• DOI: 10.1097/SLA.0000000000002825
• Languages: English
• ISSNs: 0003-4932

Abstract

Abstract : Objective: Developing pragmatic data-driven algorithms for management of trauma induced coagulopathy (TIC) during trauma hemorrhage for viscoelastic hemostatic assays (VHAs). Background: Admission data from conventional coagulation tests (CCT), rotational thrombelastometry (ROTEM) and thrombelastography (TEG) were collected prospectively at 6 European trauma centers during 2008 to 2013. Methods: To identify significant VHA parameters capable of detecting TIC (defined as INR > 1.2), hypofibrinogenemia (< 2.0 g/L), and thrombocytopenia (< 100 x10 9 /L), univariate regression models were constructed. Area under the curve (AUC) was calculated, and threshold values for TEG and ROTEM parameters with 70% sensitivity were included in the algorithms. Results: A total of, 2287 adult trauma patients (ROTEM: 2019 and TEG: 968) were enrolled. FIBTEM clot amplitude at 5 minutes (CA5) had the largest AUC and 10 mm detected hypofibrinogenemia with 70% sensitivity. The corresponding value for functional fibrinogen (FF) TEG maximum amplitude (MA) was 19 mm. Thrombocytopenia was similarly detected using the calculated threshold EXTEM-FIBTEM CA5 30 mm. The corresponding rTEG-FF TEG MA was 46 mm. TIC was identified by EXTEM CA5 41 mm, rTEG MA 64 mm (80% sensitivity). For hyperfibrinolysis, we examined the relationship between viscoelastic lysis parameters and clinical outcomes, with resulting threshold values of 85% for EXTEM Li30 and 10% for rTEG Ly30. Based on these analyses, we constructed algorithms for ROTEM, TEG, and CCTs to be used in addition to ratio driven transfusion and tranexamic acid. Conclusions: We describe a systematic approach to define threshold parameters for ROTEM and TEG. These parameters were incorporated into algorithms to support data-driven adjustments of resuscitation with therapeutics, to optimize damage control resuscitation practice in trauma. Abstract : Supplemental Digital Content is available in the text