Accelerating availability of clinically-relevant parameter estimates from thromboelastogram point-of-care device

Abstract

BACKGROUND Modeling approaches offer a novel way to detect and predict coagulopathy in trauma patients. A dynamic model, built and tested on thromboelastogram (TEG) data, was used to generate a virtual library of over 160,000 simulated RapidTEGs. The patient-specific parameters are the initial platelet count, platelet activation rate, thrombus growth rate, and lysis rate (P(0), k1, k2, and k3, respectively). METHODS Patient data from both STAAMP (n = 182 patients) and PAMPer (n = 111 patients) clinical trials were collected. A total of 873 RapidTEGs were analyzed. One hundred sixteen TEGs indicated maximum amplitude (MA) below normal and 466 TEGs indicated lysis percent above normal. Each patient's TEG response was compared against the virtual library of TEGs to determine library trajectories having the least sum-of-squared error versus the patient TEG up to each specified evaluation time ∈ (3, 4, 5, 7.5, 10, 15, 20 minutes). Using 10 nearest-neighbor trajectories, a logistic regression was performed to predict if the patient TEG indicated MA below normal (<50 mm), lysis percent 30 minutes after MA (LY30) greater than 3%, and/or blood transfusion need using the parameters from the dynamic model. RESULTS The algorithm predicts abnormal MA values using the initial 3 minutes of RapidTEG data with a median area under the curve of 0.95, and improves with more data to 0.98 by 10 minutes. Prediction of future platelet and packed red blood cell transfusion based on parameters at 4 and 5 minutes, respectively, provides equivalent predictions to the traditional TEG parameters in significantly less time. Dynamic model parameters could not predict abnormal LY30 or future fresh-frozen plasma transfusion. CONCLUSION This analysis could be incorporated into TEG software and workflow to quickly estimate if the MA would be below or above threshold value within the initial minutes following a TEG, along with an estimate of what blood products to have on hand. LEVEL OF EVIDENCE Therapeutic/Care Management: Level IV.

Personalized modulation of coagulation factors using a thrombin dynamics model to treat trauma-induced coagulopathy

“…These protocols are also non-dynamic, meaning that they are unable to make time-course, patient-specific predictions of recovery, and they do not facilitate future intervention automation. A recent thromboelastogram modeling advance 45 , while promising, has yet to be deployed for dynamic treatment schemes.…”

Viscoelastic monitoring in trauma resuscitation

“…ROTEM can detect treatment with and response to fibrinogen, plasma, platelets, and TXA in critically injured trauma patients 194 . Recent work suggests that clinically‐relevant parameters may be estimated earlier in the course of TEG assay processing thereby facilitating a more comprehensive understanding of resuscitation needs 195 . Device development to improve reliability, repeatability, and ease of data generation continues to improve potential for widespread application 77 .…”

“…194 Recent work suggests that clinically-relevant parameters may be estimated earlier in the course of TEG assay processing thereby facilitating a more comprehensive understanding of resuscitation needs. 195 Device development to improve reliability, repeatability, and ease of data generation continues to improve potential for widespread application. 77 As point of care testing develops and utilization becomes more widespread, our understanding of application to trauma resuscitation is likely to grow.…”

Hemorrhagic Resuscitation Guided by Viscoelastography in Far-Forward Combat and Austere Civilian Environments: Goal-Directed Whole-Blood and Blood-Component Therapy Far from the Trauma Center

“…Other groups have attempted to adapt predictive algorithms to obtain the key results from standard TEG ® assays based on early reaction conditions [119,120]. A more recent effort by Pressley et al analyzed 873 r-TEG ® readings and developed an algorithm that could predict the need for transfusion of platelets or RBCs in 4 and 5 min, respectively [121]. This work makes the cheaper and more accessible standard TEG ® arguably on par with the r-TEG ® run time.…”