TEG/ROTEM-driven resuscitation in trauma

Abstract

Personalized medicine employs diagnostic testing to target the optimal care for the individual patient. In trauma, algorithmic rapid decision-making is common, as timely intervention is critical. This is particularly true in actively bleeding patients. To combat bleeding, empiric ratios of red blood cells (RBCs), plasma (FFP), and platelets are used in massive transfusion protocols to deliver blood-based resuscitation in a timely fashion. However, blood product transfusions are not without risks. A balance of judicious blood product utilization while not falling behind on a hemostatic resuscitation is critical. Clinical judgment and laboratory assessment work synergistically to correct bleeding. Hemostasis is achieved by both mechanical (surgical) interventions and a physiologically intact coagulation system. Viscoelastic testing via thromboelastography provides an alternative approach to assessing the coagulation status of the injured patient, one that provides both measured values and a real-time visualization of the clot initiation, consolidation, and then lysis process. This technology is becoming increasingly utilized in many civilian trauma centers and has also been introduced in the combat setting at select Role 3 facilities. This chapter will discuss the practical application of viscoelastic testing for the end user who may have little to no previous experience with this technology.