Thromboelastography in Orthopaedic Trauma Acute Pelvic Fracture Resuscitation: A Descriptive Pilot Study

The use of viscoelastic haemostatic assays in the management of major bleeding

“…The observational studies provide low quality data suggesting that VHA‐guided transfusion algorithms (mostly TEG) reduce mortality (Johansson & Stensballe, ; Schochl et al , ; Kashuk et al , ; Tapia et al , ); change transfusion practices when compared to empiric therapy (Tapia et al , ; Mamczak et al , ) and reduce/avoid allogeneic transfusion (Schochl et al , ; Yin et al , ). Data from a pre‐ and post‐implementation military study demonstrated increased use of blood components (platelets four‐fold and cryoprecipitate two‐fold) after incorporating ROTEM into resuscitation practices (Prat et al , ) despite similar patient characteristics and rates of coagulopathy.…”

Recommendations from the ICM-VTE: General

“…In tandem, orthopaedic literature on the use of VHA also surrounds trauma resuscitation and severe hemorrhage. Modified TEG with platelet mapping demonstrated a reduced ratio of fresh frozen plasma (1 unit) to packed red cells (2.5 units) and platelets (2.8 units) during massive transfusion of severe pelvic fractures 657 . In a different study, TEG reaction time (R-time) > 6 min was found to be an independent risk factor for death in patients with pelvic fractures (odds ratio [OR] 16; 95% confidence interval [CI] 5.4 - 53, p = 0.0010) with no significant association with CCT 658 .…”

Management of Pelvic Ring Injury Patients With Hemodynamic Instability

“…Recognition of this has driven the increasing incorporation of factor transfusion in the resuscitative process. In addition to the common measures of coagulopathy (e.g., PT and PTT), there have been recent advances in laboratory medicine such as thromboelastography or rotational thromboelastometry which seek to identify whether a coagulopathy can be attributed to platelet function, clotting strength, or fibrinolysis and thereby guide treatment in polytrauma patients with PRIs (68)(69)(70)(71). However, such methods are not yet widely available (54).…”