Rotational thromboelastometry (ROTEM) profile in a cohort of asystole donors

Barea‐Mendoza, Jesús Abelardo; Terceros-Almanza, L.J.; García-Fuentes, C.; Bermejo-Aznárez, S.; Portillo, Ivan; Mudarra-Reche, C.; Valiente-Fernández, M.; Rodríguez-Biendicho, A.; García-Arriaza, Juan; Chico‐Fernández, Mario

doi:10.1016/j.medine.2019.06.003

Cited by 4 publications

(5 citation statements)

References 22 publications

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“…Overall, our results show that only pFB and TEG‐MA were moderately associated with severe bleeding, although their predictive ability was far from optimal. This is in line with the findings of previous publications, which produced heterogeneous results regarding the predictive value of SLTs and viscoelastic tests for bleeding in critically ill patients with coagulopathy. Differences in design, clinical scenarios, and the time of sampling could partially explain these controversial results.…”

Section: Discussionsupporting

confidence: 92%

Relationship of thromboelastography and conventional clotting test values with severe bleeding in critically ill patients with coagulopathy: A prospective study

Casado-Méndez

Fernández-Pacheco

Arellano-Orden

et al. 2019

Int J Lab Hematology

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Introduction This study aimed to ascertain the associations of thromboelastography (TEG®) and standard laboratory test (SLTs) values with the presence of bleeding in critically ill patients with known coagulopathy. Methods Three groups of coagulopathic patients with (a) hepatic failure, (b) postoperative period after prolonged cardiac surgery, and (c) complex abdominal surgery with sepsis were prospectively included in this study. On intensive care unit (ICU) admission, patients were stratified into two groups according to whether they had major bleeding (MB) (evident overt bleeding, important bleeding apparent on imaging studies, and/or need for moderate‐massive blood transfusion and hemodynamic instability). Blood samples were drawn for the SLTs (international normalized ratio [INR], activated partial thromboplastin time [aPTT], platelet count, and fibrinogen level [Clauss]) and TEG whole blood coagulation assays. Receiver operating characteristic (ROC) curves were generated to determine the efficiency of TEG and SLTs for detecting bleeding. The correlations between SLTs and TEG parameters with similar coagulation profiles were evaluated by Spearman rank‐order analysis. Results Eighty‐three patients were included, and bleeding was confirmed in 45 (54%). The fibrinogen level demonstrated the best accuracy for detecting bleeding with an area under the curve and 95% confidence intervals [AUC (95% CI)] of 0.74 (0.63‐0.85) with the best cutoff value of ≤ 2 g/L. Regarding TEG‐MA, the AUC (CI) obtained with the optimal cutoff value of ≤ 51 mm was 0.68 (0.56‐0.80). Conclusions Both conventional clotting tests and TEG values were poorly associated with bleeding in this critically ill cohort of patients with coagulopathy.

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Section: Discussionsupporting

confidence: 92%

Relationship of thromboelastography and conventional clotting test values with severe bleeding in critically ill patients with coagulopathy: A prospective study

Casado-Méndez

Fernández-Pacheco

Arellano-Orden

et al. 2019

Int J Lab Hematology

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“…Early ROTEM analysis has likewise revealed a high incidence of hyperfibrinolysis for those patients who had long cardiac arrest times and poor prognosis. Specifically, hyperfibrinolysis criteria have been recorded in 83% of patients with long cardiac arrest times, and these patients also had lower fibrinogen levels with corresponding low levels of FIBTEM MCF (Barea-Mendoza et al, 2019).…”

Section: Post-cardiac Arrest Syndrome (Pcas)associated Coagulopathymentioning

confidence: 99%

SHock-INduced Endotheliopathy (SHINE): A mechanistic justification for viscoelastography-guided resuscitation of traumatic and non-traumatic shock

Bunch

Chang²,

Moore³

et al. 2023

Front. Physiol.

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Irrespective of the reason for hypoperfusion, hypocoagulable and/or hyperfibrinolytic hemostatic aberrancies afflict up to one-quarter of critically ill patients in shock. Intensivists and traumatologists have embraced the concept of SHock-INduced Endotheliopathy (SHINE) as a foundational derangement in progressive shock wherein sympatho-adrenal activation may cause systemic endothelial injury. The pro-thrombotic endothelium lends to micro-thrombosis, enacting a cycle of worsening perfusion and increasing catecholamines, endothelial injury, de-endothelialization, and multiple organ failure. The hypocoagulable/hyperfibrinolytic hemostatic phenotype is thought to be driven by endothelial release of anti-thrombogenic mediators to the bloodstream and perivascular sympathetic nerve release of tissue plasminogen activator directly into the microvasculature. In the shock state, this hemostatic phenotype may be a counterbalancing, yet maladaptive, attempt to restore blood flow against a systemically pro-thrombotic endothelium and increased blood viscosity. We therefore review endothelial physiology with emphasis on glycocalyx function, unique biomarkers, and coagulofibrinolytic mediators, setting the stage for understanding the pathophysiology and hemostatic phenotypes of SHINE in various etiologies of shock. We propose that the hyperfibrinolytic phenotype is exemplified in progressive shock whether related to trauma-induced coagulopathy, sepsis-induced coagulopathy, or post-cardiac arrest syndrome-associated coagulopathy. Regardless of the initial insult, SHINE appears to be a catecholamine-driven entity which early in the disease course may manifest as hyper- or hypocoagulopathic and hyper- or hypofibrinolytic hemostatic imbalance. Moreover, these hemostatic derangements may rapidly evolve along the thrombohemorrhagic spectrum depending on the etiology, timing, and methods of resuscitation. Given the intricate hemochemical makeup and changes during these shock states, macroscopic whole blood tests of coagulative kinetics and clot strength serve as clinically useful and simple means for hemostasis phenotyping. We suggest that viscoelastic hemostatic assays such as thromboelastography (TEG) and rotational thromboelastometry (ROTEM) are currently the most applicable clinical tools for assaying global hemostatic function—including fibrinolysis—to enable dynamic resuscitation with blood products and hemostatic adjuncts for those patients with thrombotic and/or hemorrhagic complications in shock states.

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“…Barea‐Mendoza et al characterized the ROTEM profile in a cohort of 18 patients who underwent organ donation after uncontrolled cardiac death (i.e., after cardiac arrest). These patients who failed to achieve ROSC exhibited a prolonged clotting time (median [IQR] 126 s [104–191]) and clot formation time (247 s [203–694]) and 83.3% met criteria for hyperfibrinolysis 39 . In the PoHCAR study, 30 patients post‐ROSC with a likely cardiac cause of out‐of‐hospital cardiac arrest (OHCA) were compared with 30 patients admitted with STEMI without cardiac arrest.…”

Section: Cardiac Arrestmentioning

confidence: 99%

“…In an animal model, platelet aggregation and clotting kinetics were significantly impaired during cardiopulmonary resuscitation after electrically-induced ventricular fibrillation arrest. 38 39 In the PoHCAR study, 30 patients post-ROSC with a likely cardiac cause of out-of-hospital cardiac arrest (OHCA) were compared with 30 patients admitted with STEMI without cardiac arrest. ROTEM and platelet function assessments were performed at hospital admission and at several time points following PCI.…”

Section: Cardiac Arrestmentioning

confidence: 99%

Non‐trauma uses of viscoelastic hemostatic assays in critical care: A narrative review and primer for pharmacists

Smith

Barlow

et al. 2023

J Am Coll Clin Pharm

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Thromboelastography (TEG) and rotational thromboelastometry (ROTEM) are point‐of‐care viscoelastic tests of whole blood that provide real‐time analyses of coagulation. TEG and ROTEM are often used to guide blood product administration in the trauma and surgical settings. These tests are increasingly being explored for their use in other disease states encountered in critically ill patients and in the management of antithrombotic medications. As the medication experts, pharmacists should be familiar with how to interpret and apply viscoelastic tests to disease state and medication management. The purpose of this narrative review is to provide a primer for pharmacists on viscoelastic tests and their interpretation and to explore non‐trauma indications for viscoelastic testing in critical care. Literature evaluating the use of TEG and ROTEM for patients with acute and chronic liver disease, ischemic and hemorrhagic stroke, myocardial infarction, cardiac arrest, coronavirus disease 2019, and extracorporeal membrane oxygenation are described. Current applications of viscoelastic tests by pharmacists and potential future roles of critical care pharmacists in expanding the use of viscoelastic tests are summarized.

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Rotational thromboelastometry (ROTEM) profile in a cohort of asystole donors

Cited by 4 publications

References 22 publications

Relationship of thromboelastography and conventional clotting test values with severe bleeding in critically ill patients with coagulopathy: A prospective study

Relationship of thromboelastography and conventional clotting test values with severe bleeding in critically ill patients with coagulopathy: A prospective study

SHock-INduced Endotheliopathy (SHINE): A mechanistic justification for viscoelastography-guided resuscitation of traumatic and non-traumatic shock

Non‐trauma uses of viscoelastic hemostatic assays in critical care: A narrative review and primer for pharmacists

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