Evolution of coagulopathy monitoring in military damage-control resuscitation

Tarmey, Nicholas T.; Woolley, Tom; Jansen, Jan O.; Doran, Catherine; Easby, Dudley T.; Wood, P.R.; Midwinter, Mark J.

doi:10.1097/ta.0b013e31827546c0

Cited by 14 publications

(6 citation statements)

References 41 publications

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“…60,61 Recent data from a military hospital revealed that, among trauma patients, 64% of all TEM traces taken on admission were abnormal. 62 Compared with SCTs, TEM discovered significantly more abnormal results ( p = 0.0005). A retrospective analysis of severely injured trauma patients (n = 44) presenting at a combat support hospital compared the results of conventional coagulation tests with r-TEG.…”

Section: Potential To Diagnose Trauma-induced Coagulopathy By Vtsmentioning

confidence: 93%

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Practical application of point-of-care coagulation testing to guide treatment decisions in trauma

Schöchl

Voelckel

Grassetto

et al. 2013

Journal of Trauma and Acute Care Surgery

102

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E xsanguination is responsible for 30% to 40% of trauma-related deaths. 1,2 Most of these fatalities occur in the prehospital setting. According to standard coagulation tests (SCTs), one quarter to one third of trauma patients present with coagulopathy on admission to the emergency department. 3Y5 The presence of coagulopathy increases the risk for poor outcomes, thus resulting in threefold to fourfold higher mortality rates. 3,5 Coagulopathic patients are at risk of exsanguination. It is assumed that up to 20% of these fatalities are potentially preventable by early hemostatic intervention. 6 Therefore, timely and reliable identification of the underlying cause of bleeding is paramount to improve survival.Despite remarkable advances in knowledge, the etiology of trauma-induced coagulopathy (TIC) is still not fully understood. Recent concepts suggest an ''endogenous'' TIC primarily driven by shock-associated hypoperfusion in combination with tissue trauma, which activates the protein C pathway, resulting in anticoagulation, hypofibrinogenemia, hyperfibrinolysis (HF), and platelet dysfunction. 7,8 In addition, ''exogenous'' factors such as consumption of coagulation proteins, in particular fibrinogen, and dilution of the remaining coagulation factors, accompanied by other potentiating effects, such as acidosis, hypothermia, and electrolyte disturbance, further contribute to TIC. 9 Importantly, TIC is not uniform but varies with pattern of injury and in type during the course of treatment, underscoring the potential importance of point-of-care (POC) testing that can rapidly provide information on an actual individual patient's coagulation status. 10 Conventional plasma-based coagulation testing, such as prothrombin time (PT) or international normalized ratio (INR), and activated partial thromboplastin time (aPTT) fail to fully assess the clotting process. SCTs were designed to evaluate anticoagulation therapy rather than coagulopathy in major trauma. 11 In fact, none of the conventional coagulation tests was developed to predict bleeding or to guide coagulation in the surgical setting. 11Y14 Moreover, a substantial amount of precious time transpires before the results of standard coagulation assessments become available, with a median turnaround time for these tests to be completed at a central laboratory ranging from 78 minutes to 88 minutes. 15,16 Viscoelastic tests (VETs), most commonly thrombelastography (TEG, Haemoscope-Haemonetics, Niles, IL) and rotational thromboelastometry (TEM, Tem Systems Inc., Durham, NC), provide a valuable alternative or an adjunct to SCT in the setting of bleeding in the emergency department. VETs yield rapid, POC assessment of whole-blood coagulation in a variety of conditions in which conventional testing may not be sensitive. 12,15,17,18 Unlike SCT, VETs provide a rapid and dynamic bedside assessment of the initiation and kinetics of clot formation, maximum clot firmness (MCF), and clot breakdown. 12,17,18 VETs can characterize the range of acute coagulopathies present in patient...

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Section: Potential To Diagnose Trauma-induced Coagulopathy By Vtsmentioning

confidence: 93%

“…66 These coagulopathies can be identified by TEM but often are missed with conventional coagulation testing. 62 In Figure 4. TEM-guided treatment algorithm: managing TIC and diffuse microvascular bleeding (AUVA Trauma Hospital, Salzburg, Austria).…”

Section: Prediction Of Bleeding Massive Transfusion and Mortality Bmentioning

confidence: 94%

Practical application of point-of-care coagulation testing to guide treatment decisions in trauma

Schöchl

Voelckel

Grassetto

et al. 2013

Journal of Trauma and Acute Care Surgery

102

View full text Add to dashboard Cite

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“…Thromboembolic events are common in trauma patients, with an incidence of 1 to 58% (depending on the study and the method of thrombus detection). 77 As there are no conventional tests which can diagnose hypercoagulability, VHAs might be of value in their prediction.…”

Section: Prediction Of Thromboembolic Eventsmentioning

confidence: 99%

Viscoelastic Testing in Trauma

Wirtz

Baumann

Klinkspoor

et al. 2017

Semin Thromb Hemost

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Traumatic-induced coagulopathy (TIC) is a complex condition which develops both as a response to trauma as well as to clinical care interventions. Accurate and timely diagnostics are necessary to enable therapy aimed at correction of TIC. Viscoelastic hemostatic assays (VHA) are increasingly recognized for their potential to diagnose TIC as well as for guidance of treatment. This narrative review focuses on the evidence of the use of VHAs to diagnose TIC, to monitor efficacy of treatment of TIC during bleeding and to prognosticate outcome. Pitfalls of the use of VHA are also discussed.

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“…2). As soon as control of bleeding is achieved, our current practice is to switch towards tailored transfusion, based on clinical and laboratory assessments, including point-of-care coagulation testing with ROTEM Ò (Pentapharm, Munich, Germany) [23]. Typical ROTEM traces are shown in Fig.…”

Section: Haemostatic Resuscitationmentioning

confidence: 99%

Haemorrhage and coagulopathy in the Defence Medical Services

et al. 2012

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SummaryOver the past 12 years, the United Kingdom Defence Medical Services have evolved an integrated ‘damage control resuscitation – damage control surgery’ sequence for the management of patients sustaining complex injuries. During 2009, over 3200 units of blood products were administered as massive transfusions to severely injured UK personnel. An important part of the approach to traumatic bleeding is the early, empirical use of predefined ratios of blood and clotting products. As soon as control of bleeding is achieved, current practice is to switch towards a tailored transfusion, based on clinical and laboratory assessments, including point‐of‐care coagulation testing. A key goal is to provide resuscitation seamlessly throughout surgery, so that patients leave the operating room with their normal physiology restored. This article outlines the current management of haemorrhage and coagulation employed in Afghanistan from the point of wounding to transfer back to the National Health Service.

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Evolution of coagulopathy monitoring in military damage-control resuscitation

Cited by 14 publications

References 41 publications

Practical application of point-of-care coagulation testing to guide treatment decisions in trauma

Practical application of point-of-care coagulation testing to guide treatment decisions in trauma

Viscoelastic Testing in Trauma

Haemorrhage and coagulopathy in the Defence Medical Services

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