Viscoelastic haemostatic assays in aeromedical transport.
haemorrhage
haemostasis
point-of-care testing
prehospital care, helicopter retrieval
trauma
Journal
Emergency medicine Australasia : EMA
ISSN: 1742-6723
Titre abrégé: Emerg Med Australas
Pays: Australia
ID NLM: 101199824
Informations de publication
Date de publication:
10 2020
10 2020
Historique:
received:
05
07
2019
revised:
06
12
2019
accepted:
22
03
2020
pubmed:
13
4
2020
medline:
20
7
2021
entrez:
13
4
2020
Statut:
ppublish
Résumé
To assess the feasibility of using rotational thromboelastometry (ROTEM®)-sigma and thromboelastography (TEG®)-6s viscoelastic point-of-care assays during rotary wing aeromedical transport, and to determine the reliability of the results obtained. A single centre, prospective, observational, non-interventional feasibility study performed at Gold Coast University Hospital intensive care unit, and in a LifeFlight Retrieval Medicine operated Leonardo AW139 helicopter. Blood was collected from eight healthy volunteers on 18 April 2019 and all testing was performed on that day. Functions measured were ROTEM-sigma extrinsically activated thromboelastometry (EXTEM) clotting time (CT), EXTEM amplitude at 5 min after CT (A5) and fibrin-based extrinsically activated thromboelastometry (FIBTEM) A5, and TEG-6s Kaolin (CK) reaction time (R), functional fibrinogen (CFF) maximal amplitude (MA) and CFF amplitude at 10 min after R (A10). Differences between the results obtained in the helicopter and control results at Gold Coast University Hospital during flight and after flight, and also differences in control results over time up to 3 h were analysed. During flight both the ROTEM-sigma and TEG-6s devices failed to give reliable results. Post flight, the helicopter and control samples correlated well. Repeat testing of control samples at 1 and 3 h also revealed good correlation over time. It is feasible to reliably run tests on both the ROTEM-sigma and TEG-6s after the devices have been flown in a rotary wing aircraft. However, testing cannot be performed while in flight conditions. It is also possible to run blood samples collected up to 3 h prior and acquire results which correlate well with initial testing.
Identifiants
pubmed: 32279464
doi: 10.1111/1742-6723.13510
doi:
Substances chimiques
Hemostatics
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
786-792Subventions
Organisme : Gold Coast University Hospital Critical Care Research Group
Pays : International
Informations de copyright
© 2020 Australasian College for Emergency Medicine.
Références
Cothren CC, Moore EE, Hedegaard HB, Meng K. Epidemiology of urban trauma deaths: a comprehensive reassessment 10 years later. World J. Surg. 2007; 31: 1507-11.
Kauvar DS, Wade CE. The epidemiology and modern management of traumatic hemorrhage: US and international perspectives. Crit. Care 2005; 9 (Suppl 5): S1-9.
Tien HC, Spencer F, Tremblay LN, Rizoli SB, Brenneman FD. Preventable deaths from hemorrhage at a level I Canadian trauma center. J. Trauma 2007; 62: 142-6.
Evans JA, van Wessem KJ, McDougall D et al. Epidemiology of traumatic deaths: comprehensive population based assessment. World J. Surg. 2010; 34: 158-63.
Brohi K, Cohen MJ, Davenport RA. Acute coagulopathy of trauma: mechanism, identification and effect. Curr. Opin. Crit. Care 2007; 13: 680-5.
Simmons JW, Pittet JF, Pierce B. Trauma-induced coagulopathy. Curr. Anesthesiol. Rep. 2014; 4: 189-99.
Davenport RA, Brohi K. Cause of trauma-induced coagulopathy. Curr. Opin. Anaesthesiol. 2016; 29: 212-9.
Brohi K, Cohen MJ, Ganter MT et al. Acute coagulopathy of trauma: hypoperfusion induces systemic anticoagulation and hyperfibrinolysis. J. Trauma 2008; 64: 1211-7.
Brohi K, Cohen MJ, Ganter MT, Matthay MA, Mackersie RC, Pittet JF?? Acute traumatic coagulopathy: initiated by hypoperfusion: modulated through the protein C pathway? Ann. Surg. 2007; 245: 812-8.
Floccard B, Rugeri L, Faure A et al. Early coagulopathy in trauma patients: an on-scene and hospital admission study. Injury 2012; 43: 26-32.
Brohi K, Singh J, Heron M, Coats T. Acute traumatic coagulopathy. J. Trauma 2003; 54: 1127-30.
MacLeod JB, Lynn M, McKenney MG et al. Early coagulopathy predicts mortality in trauma. J. Trauma 2003; 55: 39-44.
Haas T, Fries D, Tanaka KA, Asmis L, Curry NS, Schöchl H. Usefulness of standard plasma coagulation tests in the management of perioperative coagulopathic bleeding: is there any evidence? Br. J. Anaesth. 2015; 114: 217-24.
Toulon P, Ozier Y, Ankri A, Fléron MH, Leroux G, Samama CM. Point-of-care versus central laboratory coagulation testing during haemorrhagic surgery. A multicenter study. Thromb. Haemost. 2009; 101: 394-401.
Davenport R, Manson J, De'Ath H et al. Functional definition and characterization of acute traumatic coagulopathy. Crit. Care Med. 2011; 39: 2652-8.
Johansson PI, Stensballe J. Effect of haemostatic control resuscitation on mortality in massively bleeding patients: a before and after study. Vox Sang. 2009; 96: 111-8.
Baksaas-Aasen K, Van Dieren S, Balvers K et al. Data-driven development of ROTEM and TEG algorithms for the management of trauma haemorrhage. A prospective observational multicenter study. Ann. Surg. 2019; 270: 1178-85.
Ziegler B, Schimke C, Marchet P, Stögermüller B, Schöchl H, Solomon C. Severe pediatric blunt trauma - successful ROTEM-guided hemostatic therapy with fibrinogen concentrate and no administration of fresh frozen plasma or platelets. Clin. Appl. Thromb. Hemost. 2013; 19: 453-9.
Schaden E, Kimberger O, Kraincuk P, Baron DM, Metnitz PG, Kozek-Langenecker S. Perioperative treatment algorithm for bleeding burn patients reduces allogeneic blood product requirements. Br. J. Anaesth. 2012; 109: 376-81.
Gonzalez E, Moore EE, Moore HB et al. Goal-directed hemostatic resuscitation of trauma-induced coagulopathy: a pragmatic randomized clinical trial comparing viscoelastic assay to conventional coagulation assays. Ann. Surg. 2016; 263: 1051-9.
Hagemo JS, Christiaans SC, Stanworth SJ et al. Detection of acute traumatic coagulopathy and massive transfusion requirements by means of rotational thromboelastometry: an international prospective validation study. Crit. Care 2015; 19: 97.
Johansson PI, Stissing T, Bochsen L, Ostrowski SR. Thrombelastography and tromboelastometry in assessing coagulopathy in trauma. Scand. J. Trauma Resusc. Emerg. Med. 2009; 17: 45.
Tauber H, Innerhofer P, Breitkopf R et al. Prevalence and impact of abnormal ROTEM(R) assays in severe blunt trauma: results of the 'Diagnosis and treatment of trauma-induced coagulopathy (DIA-TRE-TIC) study'. Br. J. Anaesth. 2011; 107: 378-87.
Schochl H, Cotton B, Inaba K et al. FIBTEM provides early prediction of massive transfusion in trauma. Crit. Care 2011; 15: R265.
Rugeri L, Levrat A, David JS et al. Diagnosis of early coagulation abnormalities in trauma patients by rotation thrombelastography. J. Thromb. Haemost. 2007; 5: 289-95.
Gill M. The TEG6s on shaky ground? A novel assessment of the TEG6s performance under a challenging condition. J. Extra Corpor. Technol. 2017; 49: 26-9.
Meledeo MA, Peltier GC, McIntosh CS et al. Functional ability of the TEG 6s hemostasis analyzer under stress. J. Trauma Acute Care Surg. 2018; 84 (6S Suppl 1): S83-8.
Scott R, Burns B, Ware S, Oud F, Miller M. The reliability of thromboelastography in a simulated rotary wing environment. Emerg. Med. J. 2018; 35: 739-42.
Roberts TR, Jones JA, Choi JH et al. Thromboelastography on-the-go: evaluation of the TEG 6s device during ground and high-altitude evacuation with extracorporeal life support. J. Trauma Acute Care Surg. 2019; 87(1S Suppl 1): S119-S127.
Martin J, Schuster T, Moessmer G, Kochs EF, Wagner KJ. Alterations in rotational thromboelastometry (ROTEM®) parameters: point-of-care testing vs analysis after pneumatic tube system transport. Br. J. Anaesth. 2012; 109: 540-5.