Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany.
Tem Innovations, Munich, Germany.
Korean J Anesthesiol. 2019 Aug;72(4):297-322. doi: 10.4097/kja.19169. Epub 2019 May 17.
Rotational thromboelastometry (ROTEM) is a point-of-care viscoelastic method and enables to assess viscoelastic profiles of whole blood in various clinical settings. ROTEM-guided bleeding management has become an essential part of patient blood management (PBM) which is an important concept in improving patient safety. Here, ROTEM testing and hemostatic interventions should be linked by evidence-based, setting-specific algorithms adapted to the specific patient population of the hospitals and the local availability of hemostatic interventions. Accordingly, ROTEM-guided algorithms implement the concept of personalized or precision medicine in perioperative bleeding management ('theranostic' approach). ROTEM-guided PBM has been shown to be effective in reducing bleeding, transfusion requirements, complication rates, and health care costs. Accordingly, several randomized-controlled trials, meta-analyses, and health technology assessments provided evidence that using ROTEM-guided algorithms in bleeding patients resulted in improved patient's safety and outcomes including perioperative morbidity and mortality. However, the implementation of ROTEM in the PBM concept requires adequate technical and interpretation training, education and logistics, as well as interdisciplinary communication and collaboration.
旋转血栓弹性描记术（ROTEM）是一种即时检测的粘弹性检测方法，能够评估各种临床环境下全血的粘弹性特征。ROTEM 引导的出血管理已经成为患者血液管理（PBM）的重要组成部分，而患者血液管理是提高患者安全性的重要理念。在这里，ROTEM 检测和止血干预措施应该通过基于证据的、特定于环境的算法进行关联，这些算法需要适应医院特定患者人群和当地可用的止血干预措施。因此，ROTEM 引导的算法在围手术期出血管理中实施了个性化或精准医学的概念（“治疗诊断”方法）。ROTEM 引导的 PBM 已被证明可有效减少出血、输血需求、并发症发生率和医疗保健成本。因此，多项随机对照试验、荟萃分析和卫生技术评估提供了证据，表明在出血患者中使用 ROTEM 引导的算法可提高患者的安全性和结局，包括围手术期发病率和死亡率。然而，在 PBM 概念中实施 ROTEM 需要足够的技术和解释培训、教育和后勤支持，以及跨学科的沟通与协作。
