Thrombelastography (TEG(R) 6s) early amplitudes predict maximum amplitude in severely injured trauma patients

被引：3

作者：

Vigstedt, Martin ^{[1
]}

Baksaas-Aasen, Kjersti ^{[2
,3
]}

Henriksen, Hanne H. ^{[1
]}

Maegele, Marc ^{[4
]}

Stanworth, Simon ^{[5
,6
]}

Juffermans, Nicole P. ^{[7
]}

Kolstadbraten, Knut M. ^{[2
,3
]}

Naess, Pal A. ^{[2
,3
]}

Brohi, Karim ^{[8
]}

Gaarder, Christine ^{[2
,3
]}

Stensballe, Jakob ^{[1
,9
]}

Johansson, Par, I ^{[1
]}

机构：

[1] Copenhagen Univ Hosp, Rigshosp, Sect Transfus Med, Capital Reg Blood Bank, 2034,Blegdamsvej 9, DK-2100 Copenhagen, Denmark

[2] Oslo Univ Hosp, Oslo, Norway

[3] Univ Oslo, Oslo, Norway

[4] Univ Witten Herdecke, Cologne Merheim Med Ctr, Cologne, Germany

[5] Oxford Univ Hosp NHS Trust, Oxford, England

[6] NHS Blood & Transplant, Bristol, Avon, England

[7] Amsterdam Univ Med Ctr, Lab Expt Intens Care & Anesthesiol, Amsterdam, Netherlands

[8] Queen Mary Univ London, Ctr Trauma Sci, London, England

[9] Copenhagen Univ Hosp, Rigshosp, Ctr Head & Orthopaed, Dept Anaesthesiol, Copenhagen, Denmark

来源：

SCANDINAVIAN JOURNAL OF CLINICAL & LABORATORY INVESTIGATION | 2022年 / 82卷 / 06期

关键词：

Blood coagulation; hemostasis; shock; thrombelastography; trauma; TRANSFUSION;

D O I：

10.1080/00365513.2022.2119599

中图分类号：

R446 [实验室诊断]; R-33 [实验医学、医学实验];

学科分类号：

1001 ;

摘要：

Severely injured trauma patients are often coagulopathic and early hemostatic resuscitation is essential. Previous studies have revealed linear relationships between thrombelastography (TEG(R)) five- and ten-min amplitudes (A5 and A10), and maximum amplitude (MA), using TEG(R) 5000 technology. We aimed to investigate the performance of A5 and A10 in predicting low MA in severely injured trauma patients and identify optimal cut-off values for hemostatic intervention based on early amplitudes, using the cartridge-based TEG(R) 6s technology. Adult trauma patients with hemorrhagic shock were included in the iTACTIC randomized controlled trial at six European Level I trauma centers between 2016 and 2018. After admission, patients were randomized to hemostatic therapy guided by conventional coagulation tests (CCT) or viscoelastic hemostatic assays (VHA). Patients with available admission-TEG(R) 6s data were included in the analysis, regardless of treatment allocation. Low MA was defined as <55 mm for Kaolin TEG(R) and RapidTEG(R), and <17 mm for TEG(R) functional fibrinogen (FF). One hundred eighty-seven patients were included. Median time to MA was 20 (Kaolin TEG(R)), 21 (RapidTEG(R)) and 12 (TEG(R) FF) min. For Kaolin TEG(R), the optimal Youden index (YI) was at A5 < 36 mm (100/93% sensitivity/specificity) and A10 < 47 mm (100/96% sensitivity/specificity). RapidTEG(R) optimal YI was at A5 < 34 mm (98/92% sensitivity/specificity) and A10 < 45 mm (96/95% sensitivity/specificity). TEG(R) FF optimal YI was at A5 < 12 mm (97/93% sensitivity/specificity) and A10 < 15 mm (97/99% sensitivity/specificity). In summary, we found that TEG(R) 6s early amplitudes were sensitive and specific predictors of MA in severely injured trauma patients. Intervening on early amplitudes can save valuable time in hemostatic resuscitation.

引用

页码：508 / 512

页数：5

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