Rotational thromboelastometry (ROTEM®)

Abstract

Thromboelastometry (ROTEM®) is an advancement of the classical thromboelastography. Several technical enhancements made already the semiautomated ROTEM® delta device more robust and user-friendly, reduced intra-and inter-operator variability, and improved the diagnostic performance. This allows for using the device at the bedside in a mobile way and in a multiuser environment, even in military settings. The new ROTEM® sigma device still uses the proven viscoelastic pin-and-cup technology but avoids any pipetting as a cartridge-based, fully automated ROTEM® device. The ROTEM® system is not only able to detect multiple aspects of trauma-induced coagulopathy (TIC) and disseminated intravascular coagulation (DIC), but also it allows for the prediction of bleeding, massive transfusion, thrombosis, and mortality, too. Furthermore, the ROTEM® device is designed to guide hemostatic therapy with allogeneic blood products (RBC, FFP, cryoprecipitate, and platelets) and, in particular, with specific coagulation factor concentrates (fibrinogen concentrate, prothrombin complex concentrate (PCC), factor XIII concentrate, and rFVIIa). Here, the combination of specific ROTEM® assays improved the diagnostic performance significantly. Finally, the implementation of ROTEM®-guided bleeding management algorithms ("Theranostic Approach") has been shown to reduce transfusion requirements, complication rates, morbidity, mortality, and hospital costs in trauma and other clinical settings. Thereby, ROTEM® implements "Precision Medicine" in hemostasis management.