Implementation of point-of-care ROTEM® into a trauma major haemorrhage protocol: A before and after study.
ROTEM®
major haemorrhage protocol
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:
Jun 2021
Jun 2021
Historique:
revised:
07
08
2020
received:
05
03
2020
accepted:
11
09
2020
medline:
1
10
2020
pubmed:
1
10
2020
entrez:
30
9
2020
Statut:
ppublish
Résumé
The aim of the present study was to assess transfusion practices with the implementation of a targeted viscoelastic haemostatic assay (VHA) (ROTEM®) guided coagulation management programme into a major haemorrhage protocol for trauma patients requiring ICU admission, starting from time of arrival in the ED. This retrospective observational study was conducted in a major trauma centre in Australia. One hundred and sixty-two trauma patients admitted to the ICU between January 2013 and December 2015 with an Injury Severity Score ≥12 and who received blood products were included: 37 in the pre-group, 48 during implementation and 77 in post-group. The primary outcome was blood and blood product administration amounts. Packed red blood cell transfusion amounts did not significantly change post introduction of the ROTEM®. There was a significant increase in fibrinogen replacement between the pre- and post-groups (P < 0.001), accompanied by a reduction in the use of fresh frozen plasma (P < 0.001) and prothrombinex (P < 0.001). Platelet usage in the post-group was higher but not reaching statistical significance (P = 0.051). Post-implementation point-of-care ROTEM® testing was able to be performed in the ED in 94.8% of cases. Although there was no overall reduction of packed red blood cell usage, a change in the pattern of administration of other blood products was observed with the implementation of a targeted VHA (ROTEM®) guided coagulation management programme. Larger studies are needed to further define the role of early VHA testing to guide correction of trauma-induced coagulopathy and the effect on clinical outcomes.
Identifiants
pubmed: 32996292
doi: 10.1111/1742-6723.13643
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
457-464Subventions
Organisme : Emergency Medicine Foundation, Gold Coast Hospital Foundation
ID : EMSS-406-R21-Campbell
Informations de copyright
© 2020 Australasian College for Emergency Medicine.
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