From the The Geneva Foundation (T.R.R., J.A.J., J.-H.C., K.N.S., G.T.H., D.S.W., B.M.B., A.I.B.), Tacoma, Washington; Morsani College of Medicine, University of South Florida, Tampa, Florida; U.S. Army Institute of Surgical Research (T.R.R., J.-H.C., D.S.W., B.M.B., A.P.C., L.C.C., A.I.B.), JBSA, Fort Sam Houston, Texas; Department of Surgery (V.R.), University of Texas Health Science Center, San Antonio, Texas; U.S. Army Medical Research and Materiel Command (M.R.D.), Fort Detrick, Maryland; San Antonio Military Medical Center (V.G.S.), JBSA, Fort Sam Houston, Texas.
J Trauma Acute Care Surg. 2019 Jul;87(1S Suppl 1):S119-S127. doi: 10.1097/TA.0000000000002224.
Coagulation monitoring capabilities during transport are limited. Thromboelastography (TEG) is a whole-blood clotting test measuring clot formation, stabilization, and fibrinolysis and is traditionally performed in a laboratory. We evaluated a new point-of-care TEG analyzer, TEG 6s (Haemonetics, Braintree, MA), in a large animal model of combat-relevant trauma managed with extracorporeal life support during ground and high-altitude aeromedical evacuation. The objective was to compare TEG 6s used during transport versus the predicate device, TEG 5000, used in the laboratory. We hypothesized that TEG 6s would be comparable with TEG 5000 during dynamically changing transport conditions.
Thromboelastography parameters (R, K, angle, MA, LY30) derived by TEG 6s and TEG 5000 were compared during transport of 8 swine. TEG 6s was transported with animals during ground transport and flight. TEG 5000 was stationary in an adjacent building. TEG 6s activated clotting time (ACT) was compared with a Hemochron Junior ACT analyzer (Accriva Diagnostics, San Diego, CA). Statistics were performed using SAS 9.4 with Deming regressions, Spearman correlations, and average differences compared.
Correlation between devices was stronger at sea-level (R, r = 0.7413; K, r = 0.7115; angle, r = 0.7192; MA, r = 0.8386; LY30, r = 0.9099) than during high-altitude transport (R, r = 0.4787; K, r = 0.4007; angle, r = 0.3706; MA, r = 0.6573; LY30, r = 0.8481). Method agreement was comparable during stationary operation (R, r = 0.7978; K, r = 0.7974; angle, r = 0.7574; MA, r = 0.7841; LY30, r = 0.9140) versus ground transport (R, r = 0.7927; K, r = 0.6246; angle, r = 0.6967; MA, r = 0.9163; LY30, r = 0.8603). TEG 6s ACT trended higher than Hemochron ACT when subjects were heparinized (average difference, 1,442 ± 1,703 seconds) without a methodological difference by Deming regression.
Mobile TEG 6s during ground and altitude transport is feasible and provides unprecedented information to guide coagulation management. Future studies should assess the precision and accuracy of TEG 6s during transport of critically ill.
在转运过程中凝血监测能力有限。血栓弹力图（TEG）是一种测量血凝块形成、稳定和纤维蛋白溶解的全血凝血测试，传统上在实验室进行。我们在使用体外生命支持治疗的与战斗相关创伤的大型动物模型中评估了一种新的即时护理 TEG 分析仪，TEG 6s（Haemonetics，Braintree，MA），用于地面和高空医疗后送中的动态变化的转运条件。目的是比较在转运过程中使用的 TEG 6s 与在实验室中使用的预测设备 TEG 5000。我们假设 TEG 6s 在动态变化的转运条件下与 TEG 5000 相比具有可比性。
在 8 头猪的转运过程中比较 TEG 6s 和 TEG 5000 得出的血栓弹力图参数（R、K、角度、MA、LY30）。TEG 6s 在地面转运和飞行期间与动物一起转运。TEG 5000 位于相邻建筑物中。TEG 6s 的激活凝血时间（ACT）与 Accriva Diagnostics 的 Hemochron Junior ACT 分析仪（圣地亚哥，加利福尼亚州）进行比较。使用 SAS 9.4 进行统计学分析，采用 Deming 回归、Spearman 相关性和平均差异比较。
在海平面（R，r = 0.7413；K，r = 0.7115；角度，r = 0.7192；MA，r = 0.8386；LY30，r = 0.9099）与高空转运（R，r = 0.4787；K，r = 0.4007；角度，r = 0.3706；MA，r = 0.6573；LY30，r = 0.8481）相比，设备之间的相关性更强。在静止操作（R，r = 0.7978；K，r = 0.7974；角度，r = 0.7574；MA，r = 0.7841；LY30，r = 0.9140）与地面转运（R，r = 0.7927；K，r = 0.6246；角度，r = 0.6967；MA，r = 0.9163；LY30，r = 0.8603）相比，方法一致性相当。当受试者肝素化时，TEG 6s ACT 趋势高于 Hemochron ACT（平均差异，1442 ± 1703 秒），但 Deming 回归未显示方法差异。
地面和高空转运期间的移动 TEG 6s 是可行的，并提供了以前无法获得的信息，以指导凝血管理。未来的研究应评估 TEG 6s 在危重病患者转运过程中的精密度和准确性。
