Thromboelastography does not provide additional information to guide resuscitation in the severely injured

Abstract

Background: Haemostasis assessment is essential to determine the early need for massive transfusion in the treatment of polytrauma. Strategies to guide correction of coagulopathy vary widely. In order to evaluate thromboelastography (TEG) for this goal, a prospective study was performed comparing TEG to conventional coagulation assays (CCAs) in severely injured patients. Methods: Consecutive polytrauma patients admitted to the intensive care unit of a level-1 trauma centre were prospectively included over a 30-month period. All patients had CCA on arrival in emergency department. Patients who needed massive transfusion and underwent urgent surgery had additionally a Kaolin-activated TEG. Results: One hundred and thirty-five patients were included, 76% male, median age 45 years, 96% blunt injuries and median injury severity score was 29. One hundred and fourteen patients had CCA only and 21 patients had both CCA and TEG. Patients who had both CCA and TEG were acidotic, hypothermic and coagulopathic on arrival in emergency department. All 21 patients had normal TEG results even though prothrombin time was prolonged. Conclusions: TEGs were normal in all polytrauma patients even though patients were severely injured. They had prolonged prothrombin time, acidosis and hypothermia both on arrival and when TEG was measured. Caution should be exercised in interpretation of TEG results in treating polytrauma patients. In our system, with aggressive early haemostatic resuscitation, TEG does not provide additional information in guiding resuscitation.

Does Liberal Prehospital and In‐Hospital Tranexamic Acid Influence Outcome in Severely Injured Patients? A Prospective Cohort Study

“…In our hospital, viscoelastic tests are not routinely used in trauma. However, in a previous study thromboelastography in severely injured patients (who were part of the same cohort used in this study) showed no abnormalities [25]; therefore, it could be assumed that the patients in this study had physiological levels of fibrinolysis. Nevertheless, there was no difference in mortality between patients who received TXA and patients who did not in this study.…”

“…In this study, 422 patients (71% male) with a median age of 46 (28-62) years admitted to ICU were included. Ninetyfive percent of injuries were caused by a blunt mechanism, 50% was prehospitally intubated, and median ISS was 29 (22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36) with most severe injuries located in the brain (AIS head 3 (1-4)) and chest (AIS chest 3 (2-4)). One hundred and three patients (24%) underwent an urgent laparotomy.…”

Detection of Acute Traumatic Coagulopathy by Viscoelastic Haemostatic Assays Compared to Standard Laboratory Tests: A Systematic Review

“…Descriptions of the 15 included study characteristics are presented in Table 1 . Therefore, the remaining 32 manuscripts were excluded from this analysis as they did not numerically report on the detection rates of ATC between VHA and SLCT [ 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 ]. The characteristics of these studies are outlined in Table 2 .…”

Massive transfusion in The Netherlands

“…Despite the restrictive policy in each centre, a recent Dutch study showed that an average of 4–5 L crystalloids is given to trauma patients in the first 8 hours after admission 22…”