Thromboelastography and rotational thromboelastometry in bleeding patients with coagulopathy: Practice management guideline from the Eastern Association for the Surgery of Trauma

被引：79

作者：

Bugaev, Nikolay ^{[1
]}

Como, John J. ^{[2
]}

Golani, Guy ^{[3
]}

Freeman, Jennifer J. ^{[4
]}

Sawhney, Jaswin S. ^{[5
]}

Vatsaas, Cory J. ^{[6
]}

Yorkgitis, Brian K. ^{[7
]}

Kreiner, Laura A. ^{[8
]}

Garcia, Nicole M. ^{[9
]}

Aziz, Hiba Abdel ^{[10
]}

Pappas, Peter A. ^{[11
]}

Mahoney, Eric J. ^{[1
]}

Brown, Zachary W. ^{[12
,13
]}

Kasotakis, George ^{[6
]}

机构：

[1] Tufts Univ, Sch Med, Tufts Med Ctr, Div Trauma & Acute Care Surg, 800 Washington St,4488, Boston, MA 02111 USA

[2] MetroHlth Med Ctr, Dept Surg, Cleveland, OH USA

[3] Soroka Med Ctr, Dept Surg A, Beer Sheva, Israel

[4] TCU & UNTHSC Sch Med, Dept Surg, Ft Worth, TX USA

[5] Maine Med Ctr, Portland, ME 04102 USA

[6] Duke Univ, Dept Surg, Sch Med, Div Trauma & Crit Care Surg, Durham, NC USA

[7] Univ Florida, Coll Med Jacksonville, Jacksonville, FL USA

[8] Case Western Univ, Sch Med, Cleveland, OH USA

[9] East Carolina Univ, Div Trauma Surg Crit Care & Acute Care Surg, Dept Surg, Brody Sch Med, Greenville, NC 27858 USA

[10] Weill Cornell Univ, Doha, Qatar

[11] Univ Cent Florida, Dept Surg, Coll Med, Orlando, FL 32816 USA

[12] 2D Marine Logist Grp, 2D Med Battalion, Camp Lejeune, NC USA

[13] Uniformed Serv Univ Hlth Sci, Dept Surg, Bethesda, MD 20814 USA

来源：

JOURNAL OF TRAUMA AND ACUTE CARE SURGERY | 2020年 / 89卷 / 06期

关键词：

Thromboelastography; TEG; rotational thromboelastometry; ROTEM; hemorrhage; BLOOD-PRODUCT USE; CARDIAC-SURGERY; COAGULATION TESTS; TRANSFUSION; THERAPY; ALGORITHM; RESUSCITATION; INSTITUTION; REPLACEMENT; PROTOCOL;

D O I：

10.1097/TA.0000000000002944

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

BACKGROUND Assessment of the immediate need for specific blood product transfusions in acutely bleeding patients is challenging. Clinical assessment and commonly used coagulation tests are inaccurate and time-consuming. The goal of this practice management guideline was to evaluate the role of the viscoelasticity tests, which are thromboelastography (TEG) and rotational thromboelastometry (ROTEM), in the management of acutely bleeding trauma, surgical, and critically ill patients. METHODS Systematic review and meta-analyses of manuscripts comparing TEG/ROTEM with non-TEG/ROTEM-guided blood products transfusions strategies were performed. The Grading of Recommendations Assessment, Development and Evaluation methodology was applied to assess the level of evidence and create recommendations for TEG/ROTEM-guided blood product transfusions in adult trauma, surgical, and critically ill patients. RESULTS Using TEG/ROTEM-guided blood transfusions in acutely bleeding trauma, surgical, and critically ill patients was associated with a tendency to fewer blood product transfusions in all populations. Thromboelastography/ROTEM-guided transfusions were associated with a reduced number of additional invasive hemostatic interventions (angioembolic, endoscopic, or surgical) in surgical patients. Thromboelastography/ROTEM-guided transfusions were associated with a reduction in mortality in trauma patients. CONCLUSION In patients with ongoing hemorrhage and concern for coagulopathy, we conditionally recommend using TEG/ROTEM-guided transfusions, compared with traditional coagulation parameters, to guide blood component transfusions in each of the following three groups: adult trauma patients, adult surgical patients, and adult patients with critical illness.

引用

页码：999 / 1017

页数：19

共 51 条

[11] First-line Therapy with Coagulation Factor Concentrates Combined with Point-of-Care Coagulation Testing Is Associated with Decreased Allogeneic Blood Transfusion in Cardiovascular Surgery A Retrospective, Single-center Cohort Study [J].