Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Transfusion. 2020 Oct;60 Suppl 6:S33-S51. doi: 10.1111/trf.16074.
Traumatic injury results in both physical and physiologic insult. Successful care of the trauma patient depends upon timely correction of both physical and biochemical injury. Trauma-induced coagulopathy is a derangement of hemostasis and thrombosis that develops rapidly and can be fatal if not corrected. Viscoelastic monitoring (VEM) assays have been developed to provide rapid, accurate, and relatively comprehensive depictions of an individual's coagulation profile. VEM are increasingly being integrated into trauma resuscitation guidelines to provide dynamic and individualized guidance to correct coagulopathy.
We performed a narrative review of the search terms viscoelastic, thromboelastography, thromboelastometry, TEG, ROTEM, trauma, injury, resuscitation, and coagulopathy using PubMed. Particular focus was directed to articles describing algorithms for management of traumatic coagulopathy based on VEM assay parameters.
Our search identified 16 papers with VEM-guided resuscitation strategies in adult patients based on TEG, 12 such protocols in adults based on ROTEM, 1 protocol for children based on TEG, and 2 protocols for children based on ROTEM.
This review presents evidence to support VEM use to detect traumatic coagulopathy, discusses the role of VEM in trauma resuscitation, provides a summary of proposed treatment algorithms, and discusses pending questions in the field.
创伤会导致身体和生理损伤。成功治疗创伤患者取决于及时纠正身体和生化损伤。创伤性凝血病是止血和血栓形成的紊乱，它会迅速发展，如果不加以纠正可能是致命的。黏弹性监测（VEM）检测已被开发用于快速、准确和相对全面地描述个体的凝血概况。VEM 越来越多地被整合到创伤复苏指南中，为纠正凝血病提供动态和个体化的指导。
我们使用 PubMed 对搜索词“黏弹性”、“血栓弹力图”、“血栓弹力计”、“TEG”、“ROTEM”、“创伤”、“损伤”、“复苏”和“凝血病”进行了叙述性综述。特别关注描述基于 VEM 检测参数的创伤性凝血病管理算法的文章。
我们的搜索确定了 16 篇基于 TEG 的成年患者 VEM 指导复苏策略的论文、12 篇基于 ROTEM 的成年患者此类方案、1 篇基于 TEG 的儿童方案和 2 篇基于 ROTEM 的儿童方案。
本综述提供了支持使用 VEM 检测创伤性凝血病的证据，讨论了 VEM 在创伤复苏中的作用，总结了拟议的治疗算法，并讨论了该领域的悬而未决的问题。
