心脏停搏供体队列中的旋转血栓弹力图（ROTEM）曲线

Rotational thromboelastometry (ROTEM) profile in a cohort of asystole donors.

作者信息

Barea-Mendoza J A, Terceros-Almanza L J, García-Fuentes C, Bermejo-Aznárez S, Prieto Del Portillo I J, Mudarra-Reche C, Valiente-Fernández M, Rodríguez-Biendicho A, Montejo González J C, Chico-Fernández M

机构信息

Grupo de Investigación en Trauma y Emergencias (GINTEM-12), Unidad de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España.

出版信息

Med Intensiva (Engl Ed). 2019 Oct;43(7):410-415. doi: 10.1016/j.medin.2018.04.007. Epub 2018 Jun 8.

DOI:10.1016/j.medin.2018.04.007

PMID:29887293

Abstract

BACKGROUND

Hypoperfusion plays a central role in shock states, and has been proposed as a coagulopathy trigger. The study of the rotational thromboelastometry (ROTEM) profile during cardiac arrest could offer new insights to the role of hypoperfusion in coagulation during shock states.

OUTCOME

To describe the ROTEM profile in a cohort of asystole donors and elucidate the incidence of hyperfibrinolysis.

DESIGN

A prospective observational study was carried out in 18 patients consecutively admitted to the ICU after out-of-hospital non-recovered cardiac arrest (CA). Initial rhythm and time between CA and admission were recorded. Conventional coagulation and ROTEM (EXTEM, APTEM, FIBTEM) tests were performed within 30minutes after blood sample collection.

SCOPE

An asystole donor reference hospital.

PARTICIPANTS

Patients admitted to the ICU after out-of-hospital non-recovered CA.

RESULTS

The median age was 50years, and 14 of the patients were men (77.8%). The time from CA to hospital admission expressed as the median (interquartile range) was 91minutes (75-104). The results of the routine tests were: INR 1.25 (1.19-1.34), aPTT 55s (45-73) and fibrinogen 161mg/dl (95-295). For the ROTEM APTEM assay the results were: CT 126s (104-191), CFT 247s (203-694). Hyperfibrinolysis criteria were recorded in 15 patients (83.3%). In addition, MCF improved in APTEM versus EXTEM. Prolonged CA times were associated to lower fibrinogen levels and lower values for MCF FIBTEM (P<.05).

CONCLUSIONS

The ROTEM assays revealed severe alterations of the clot formation parameters and a high incidence of hyperfibrinolysis.

摘要

背景

低灌注在休克状态中起核心作用，并被认为是凝血病的触发因素。研究心脏骤停期间的旋转血栓弹力图（ROTEM）特征可为低灌注在休克状态下凝血过程中的作用提供新见解。

结果

描述一组心脏停搏供体的ROTEM特征，并阐明高纤溶的发生率。

设计

对18例院外心脏骤停（CA）未恢复后连续入住重症监护病房（ICU）的患者进行前瞻性观察研究。记录初始心律以及CA与入院之间的时间。在采集血样后30分钟内进行常规凝血和ROTEM（EXTEM、APTEM、FIBTEM）检测。

范围

一家心脏停搏供体参考医院。

参与者

院外心脏骤停未恢复后入住ICU的患者。

结果

中位年龄为50岁，14例患者为男性（77.8%）。从CA到入院的时间，以中位数（四分位间距）表示为91分钟（75 - 104）。常规检测结果为：国际标准化比值（INR）1.25（1.19 - 1.34），活化部分凝血活酶时间（aPTT）55秒（45 - 73），纤维蛋白原161mg/dl（95 - 295）。对于ROTEM的APTEM检测，结果为：凝血时间（CT）126秒（104 - 191），凝血形成时间（CFT）247秒（203 - 694）。15例患者（83.3%）记录到高纤溶标准。此外，与EXTEM相比，APTEM中的最大凝血块硬度（MCF）有所改善。CA时间延长与较低纤维蛋白原水平以及MCF FIBTEM较低值相关（P<0.05）。