Doyle Gerard S, Theodore Aristotle A, Hansen J Nicholas
Division of Emergency Medicine, Department of Surgery, University of Utah, Salt Lake City, Utah, USA.
Trauma Surg Acute Care Open. 2017 Mar 2;2(1):e000049. doi: 10.1136/tsaco-2016-000049. eCollection 2017.
Acute coagulopathy of trauma is associated with high mortality and extensive use of blood products. Hemostatic resuscitation, the early administration of blood products with higher ratios of procoagulant components, may improve trauma outcomes in select cases, but can also worsen outcome if inappropriately used. Evolving approaches to hemostatic resuscitation utilize viscoelastic tests to provide a more rational basis for choosing blood component therapy regimens, but these tests are logistically rigorous. We hypothesized that coagulopathy could be detected by the failure of blood clots to remain intact when subjected to a predefined impact force.
We aim to develop a point-of-injury test for coagulopathy. We created coagulopathic blood using an ex vivo normal saline (NS) dilution model and allowed blood of varying dilutions to clot, then examined the behavior of the clotted blood when subjected to a uniform gravitationally induced sheer force.
Clots created from coagulopatic blood (diluted to ≤50% with NS) failed under gravitational challenge at a significantly higher rate than non-coagulopathic blood dilutions.
Impact thromboelastometry (ITEM) represents a simple, logistically lean method for detecting dilutional coagulopathy that may facilitate detection of trauma-induced coagulopathy. ITEM may thus function as a point-of-injury or point-of-care screening test for the presence of coagulopathy.
Diagnostic studies, Level IV.
创伤性急性凝血病与高死亡率及大量使用血液制品相关。止血复苏，即早期输注促凝成分比例更高的血液制品，在某些情况下可能改善创伤结局，但如果使用不当也可能使结局恶化。不断发展的止血复苏方法利用粘弹性试验为选择血液成分治疗方案提供更合理的依据，但这些试验在操作上要求严格。我们推测，当血凝块受到预定义的冲击力时无法保持完整，可据此检测凝血病。
我们旨在开发一种用于凝血病的即时检测方法。我们使用体外生理盐水（NS）稀释模型制备凝血病血液，让不同稀释度的血液凝固，然后检测凝固血液在受到均匀重力诱导的剪切力时的行为。
由凝血病血液（用NS稀释至≤50%）形成的凝块在重力挑战下失败的发生率显著高于非凝血病血液稀释度。
冲击血栓弹力测定法（ITEM）是一种检测稀释性凝血病的简单、操作简便的方法，可能有助于检测创伤性凝血病。因此，ITEM可作为凝血病存在与否的即时检测或床旁筛查试验。
诊断性研究，IV级。
