Department of Intensive Care Medicine, Amsterdam UMC, Academic Medical Center, Amsterdam, the Netherlands.
Trauma Unit, Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands.
J Thromb Haemost. 2019 Mar;17(3):441-448. doi: 10.1111/jth.14378. Epub 2019 Feb 17.
Essentials The response of thromboelastometry (ROTEM) parameters to therapy is unknown. We prospectively recruited hemorrhaging trauma patients in six level-1 trauma centres in Europe. Blood products and pro-coagulants prevent further derangement of ROTEM results. ROTEM algorithms can be used to treat and monitor trauma induced coagulopathy. SUMMARY: Background Rotational thromboelastometry (ROTEM) can detect trauma-induced coagulopathy (TIC) and is used in transfusion algorithms. The response of ROTEM to transfusion therapy is unknown. Objectives To determine the response of ROTEM profiles to therapy in bleeding trauma patients. Patients/Methods A prospective multicenter study in bleeding trauma patients (receiving ≥ 4 red blood cell [RBC] units) was performed. Blood was drawn in the emergency department, after administration of 4, 8 and 12 RBC units and 24 h post-injury. The response of ROTEM to plasma, platelets (PLTs), tranexamic acid (TXA) and fibrinogen products was evaluated in the whole cohort as well as in the subgroup of patients with ROTEM values indicative of TIC. Results Three hundred and nine bleeding and shocked patients were included. A mean dose of 3.8 g of fibrinogen increased FIBTEM CA5 by 5.2 mm (IQR: 4.1-6.3 mm). TXA administration decreased lysis by 5.4% (4.3-6.5%). PLT transfusion prevented further derangement of parameters of clot formation. The effect of PLTs on EXTEM ca5 values was more pronounced in patients with a ROTEM value indicative of TIC than in the whole cohort. Plasma transfusion decreased EXTEM clotting time by 3.1 s (- 10 s to 3.9 s) in the whole cohort and by 10.6 s (- 45 s to 24 s) in the subgroup of patients with a ROTEM value indicative of TIC. Conclusion The effects of therapy on ROTEM values were small, but prevented further derangement of test results. In patients with ROTEM values indicative of TIC, the efficacy of PLTs and plasma in correcting deranged ROTEM parameters is possibly more robust.
旋转血栓弹性测定法（ROTEM）可检测创伤引起的凝血障碍（TIC），并用于输血算法中。ROTEM 对输血治疗的反应尚不清楚。
确定出血性创伤患者的 ROTEM 谱对治疗的反应。
患者/方法：进行了一项前瞻性多中心研究，纳入出血性创伤患者（接受≥4 个红细胞[RBC]单位）。在急诊科采血，在给予 4、8 和 12 RBC 单位后以及受伤后 24 小时采血。在整个队列以及 ROTEM 值提示 TIC 的患者亚组中评估了 ROTEM 对血浆、血小板（PLT）、氨甲环酸（TXA）和纤维蛋白原制品的反应。
共纳入 309 例出血性休克患者。平均 3.8g 纤维蛋白原可使 FIBTEM CA5 增加 5.2mm（IQR：4.1-6.3mm）。TXA 给药可使纤溶降低 5.4%（4.3-6.5%）。PLT 输血可防止凝血参数进一步恶化。PLT 对 EXTEM ca5 值的影响在 ROTEM 值提示 TIC 的患者中比在整个队列中更为明显。血浆输血可使 EXTEM 凝血时间在整个队列中缩短 3.1s（-10s 至 3.9s），在 ROTEM 值提示 TIC 的患者亚组中缩短 10.6s（-45s 至 24s）。
治疗对 ROTEM 值的影响较小，但可防止测试结果进一步恶化。在 ROTEM 值提示 TIC 的患者中，PLT 和血浆纠正异常 ROTEM 参数的疗效可能更为显著。
