Improving decision making through presentation of viscoelastic tests as a 3D animated blood clot: the Visual Clot.
ROTEM
bleeding
coagulation
situation awareness
thromboelastometry
Journal
Anaesthesia
ISSN: 1365-2044
Titre abrégé: Anaesthesia
Pays: England
ID NLM: 0370524
Informations de publication
Date de publication:
08 2020
08 2020
Historique:
accepted:
15
12
2019
pubmed:
8
2
2020
medline:
24
7
2020
entrez:
8
2
2020
Statut:
ppublish
Résumé
Point-of-care viscoelastic coagulation tests are used increasingly and enable physicians to run precise whole blood coagulation diagnostics. However, the somewhat complicated and abstract presentation of results may hinder these advantages. For this reason, we developed the Visual Clot as an alternative mode of presentation for thrombelastometric data. An algorithm takes existing parameters from rotational thromboelastometry and creates a visual representation in the form of an animated blood clot named 'Visual Clot'. In a prospective international dual-centre study, 60 physicians were presented with rotational thromboelastometry results in the standard way or as a Visual Clot. They were then asked to make therapeutic decisions based on pathological findings. Overall proportion of correct therapeutic decisions was median (IQR [range] 100 (83-100 [39-100]) % for Visual Clot vs. 44 (25-50 [0-83]) % for standard rotational thromboelastometry presentation of results, p < 0.001. Mixed regression models yielded a mean OR (95%CI) 22.1 (13.4-36.5), p < 0.001 for correct decisions with the Visual Clot compared with standard rotational thromboelastometry, with an 18.7 (16.4-21.1), p < 0.001 second decrease in decision time. Perceived cognitive work-load was lower, and participants rated their diagnostic confidence to be higher with the Visual Clot, both p < 0.001. Although correct interpretation of standard rotational thromboelastometry results depended on previous rotational thromboelastometry knowledge and experience, Visual Clot interpretation did not. The Visual Clot improved rotational thromboelastometry-based therapeutic decisions, as pathologies can be recognised more rapidly and accurately. These findings underline the significance of an alternative additional visualisation technique that simplifies the interpretation of abstract standard data.
Types de publication
Comparative Study
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1059-1069Subventions
Organisme : Institute of Anesthesiology of the University Hospital Zurich
Pays : International
Organisme : Swiss Society of Anesthesiology and Reanimation
Pays : International
Organisme : Swiss Foundation for Anesthesia Research
Pays : International
Organisme : Vifor SA
Pays : International
Organisme : Novo Nordisk Health Care AG
Pays : International
Organisme : CSL Behring GmbH
Pays : International
Organisme : LFB Biomédicaments
Pays : International
Organisme : Octapharma AG
Pays : International
Organisme : Swiss National Science Foundation
Pays : Switzerland
Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2020 Association of Anaesthetists.
Références
Spahn DR, Bouillon B, Cerny V, et al. The European guideline on management of major bleeding and coagulopathy following trauma: Fifth edition. Critical Care 2019; 23: 98.
Kozek-Langenecker SA, Ahmed AB, Afshari A, et al. Management of severe perioperative bleeding: guidelines from the European Society of Anaesthesiology: first update 2016. European Journal of Anaesthesiology 2017; 34: 332-95.
Stein P, Kaserer A, Spahn GH, Spahn DR. Point-of-care coagulation monitoring in trauma patients. Seminars in Thrombosis and Hemostasis 2017; 43: 367-74.
Kaserer A, Casutt M, Sprengel K, Seifert B, Spahn DR, Stein P. Comparison of two different coagulation algorithms on the use of allogenic blood products and coagulation factors in severely injured trauma patients: a retrospective, multicentre, observational study. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2018; 26: 4.
Collins PW, Lilley G, Bruynseels D, et al. Fibrin-based clot formation as an early and rapid biomarker for progression of postpartum hemorrhage: a prospective study. Blood 2014; 124: 1727-36.
McNamara H, Kenyon C, Smith R, Mallaiah S, Barclay P. Four years’ experience of a ROTEM® -guided algorithm for treatment of coagulopathy in obstetric haemorrhage. Anaesthesia 2019; 74: 984-91.
Serraino GF, Murphy GJ. Routine use of viscoelastic blood tests for diagnosis and treatment of coagulopathic bleeding in cardiac surgery: updated systematic review and meta-analysis. British Journal of Anaesthesia 2017; 118: 823-33.
Wikkelsø A, Wetterslev J, Møller AM, Afshari A. Thromboelastography (TEG) or thromboelastometry (ROTEM) to monitor haemostatic treatment versus usual care in adults or children with bleeding. Cochrane Database of Systematic Reviews 2016: CD007871. https://doi.org/CD007871.pub3.
Hawkins RB, Raymond SL, Hartjes T, et al. Review: the perioperative use of thromboelastography for liver transplant patients. Transplantation Proceedings 2018; 50: 3552-8.
Welling H, Ostrowski SR, Stensballe J, et al. Management of bleeding in major burn surgery. Burns 2019; 45: 755-62.
Kvint S, Schuster J, Kumar MA. Neurosurgical applications of viscoelastic hemostatic assays. Neurosurgical Focus 2017; 43: E9.
Treliński J, Misiewicz M, Robak M, Smolewski P, Chojnowski K. Assessment of rotation thromboelastometry (ROTEM) parameters in patients with multiple myeloma at diagnosis. Thrombosis Research 2014; 133: 667-70.
Young GA, Carmona R, Cano GV. Thromboelastography and thrombin generation assay in inherited afibrinogenemia. Haemophilia 2018; 24: e410-16.
Chitlur M, Rivard GE, Lillicrap D, et al. Recommendations for performing thromboelastography/thromboelastometry in hemophilia: communication from the SSC of the ISTH. Journal of Thrombosis and Haemostasis 2014; 12: 103-6.
Young G, Sørensen B, Dargaud Y, Negrier C, Brummel-Ziedins K, Key NS. Thrombin generation and whole blood viscoelastic assays in the management of hemophilia: current state of art and future perspectives. Blood 2013; 121: 1944-50.
Srivastava A, Kelleher A. Point-of-care coagulation testing. Continuing Education in Anaesthesia, Critical Care and Pain 2013; 13: 12-16.
Endsley MR. Designing for situation awareness: an approach to user-centered design, 2nd edn. Boca Roton, FL: CRC Press, 2011.
Tscholl DW, Weiss M, Spahn DR, Noethiger CB. How to conduct multimethod field studies in the operating room: the iPad combined with a survey app as a valid and reliable data collection tool. JMIR Research Protocols 2016; 5: e4.
Tscholl DW, Handschin L, Neubauer P, et al. Using an animated patient avatar to improve perception of vital sign information by anaesthesia professionals. British Journal of Anaesthesia 2018; 121: 662-71.
Drews FA, Doig A. Evaluation of a configural vital signs display for intensive care unit nurses. Human Factors 2014; 56: 569-80.
Tscholl DW, Weiss M, Handschin L, Spahn DR, Nöthiger CB. User perceptions of avatar-based patient monitoring: a mixed qualitative and quantitative study. BMC Anesthesiology 2018; 18: 188.
Wittgenstein L. Tractatus Logico-Philosophicus. London: Routledge and Kegan Paul, 1922.
Degani A, Jorgensen C, Iverson D, Shafto M, Olson L. On organization of information: approach and early work. Ames Research Center, Moffett Field, California: National Aeronautics and Space Administration, 2009.
Pfarr J, Ganter MT, Spahn DR, Noethiger CB, Tscholl DW. Avatar-based patient monitoring with peripheral vision: a multicenter comparative eye-tracking study. Journal of Medical Internet Research 2019; 21: e13041.
Tsotsos JK. Is complexity theory appropriate for analyzing biological systems? Behavioral and Brain Sciences 1991; 14: 770-3.
Itti L, Koch C. A saliency-based search mechanism for overt and covert shifts of visual attention. Vision Research 2000; 40: 1489-506.
Wallace DJ, Angus DC, Barnato AE, Kramer AA, Kahn JM. Nighttime intensivist staffing and mortality among critically ill patients. New England Journal of Medicine 2012; 366: 2093-101.
Lockley SW, Cronin JW, Evans EE, et al. Effect of reducing interns’ weekly work hours on sleep and attentional failures. New England Journal of Medicine 2004; 351: 1829-37.
Fothergill S, Neal A. The effect of workload on conflict decision-making strategies in air traffic control. Proceedings of the Human Factors and Ergonomics Society Annual Meeting 2008; 52: 39-43.
Dawson D, Reid K. Fatigue, alcohol and performance impairment. Nature 1997; 388: 235-235.
Soh S, Kwak Y-L, Song J-W, Yoo K-J, Kim H-J, Shim J-K. Rotational thromboelastometry predicts increased bleeding after off-pump coronary bypass surgery. Annals of Thoracic Surgery 2017; 104: 1318-24.
Tanaka KA, Bolliger D, Vadlamudi R, Nimmo A. Rotational thromboelastometry (ROTEM)-based coagulation management in cardiac surgery and major trauma. Journal of Cardiothoracic and Vascular Anesthesia 2012; 26: 1083-93.