Intensive Care Unit, Gold Coast University Hospital, 1 Hospital Blvd, Southport, QLD, 4215, Australia.
Trauma Service, Gold Coast University Hospital, 1 Hospital Blvd, Southport, QLD, 4215, Australia.
Eur J Trauma Emerg Surg. 2022 Apr;48(2):1077-1084. doi: 10.1007/s00068-021-01652-w. Epub 2021 Jun 16.
Rotational thromboelastometry (ROTEM®) allows guided blood product resuscitation to correct trauma-induced coagulopathy in bleeding trauma patients. FIBTEM amplitude at 10 min (A10) has been widely used to identify hypofibrinogenaemia; locally a threshold of < 11 mm has guided fibrinogen replacement. Amplitude at 5 min (A5) carries an inherent time advantage. The primary aim was to explore the relationship between FIBTEM A5 and A10 in a trauma. Secondary aim was to investigate the use of A5 as a surrogate for A10 within a fibrinogen-replacement algorithm.
Retrospective observational cohort study of arrival ROTEM results from 1539 consecutive trauma patients at a Level 1 trauma centre in Australia. Consistency of agreement between FIBTEM A5 and A10 was assessed. A new fibrinogen replacement threshold was developed for A5 using the A5-A10 bias; this was clinically compared to the existing A10 threshold.
FIBTEM A5 displayed excellent consistency of agreement with A10. Intraclass correlation coefficient = 0.972 (95% confidence interval [CI] 0.969-0.974). Bias of A5 to A10 was - 1.49 (95% CI 1.43-1.56) mm. 19.34% patients met the original local threshold of A10 < 11 mm; 19.28% patients met the new, bias-adjusted threshold of A5 < 10 mm.
ROTEM FIBTEM A5 reliably predicts A10 in trauma. This further validates use of the A5 result over A10 allowing faster decision-making in time-critical resuscitation of trauma patients. A modification of -1 to the A10 threshold might be appropriate for use with the A5 value in trauma patients.
旋转血栓弹性测定（ROTEM®）可用于指导血液制品复苏，以纠正出血性创伤患者的创伤诱导性凝血障碍。纤维蛋白原 FIBTEM 振幅在 10 分钟（A10）时被广泛用于确定低纤维蛋白原血症；当地的阈值为 <11mm 指导纤维蛋白原替代。5 分钟时的振幅（A5）具有内在的时间优势。主要目的是探讨创伤中 FIBTEM A5 与 A10 的关系。次要目的是研究在纤维蛋白原替代算法中使用 A5 作为 A10 的替代。
回顾性观察性队列研究，纳入了澳大利亚 1 级创伤中心连续 1539 例创伤患者的到达 ROTEM 结果。评估 FIBTEM A5 与 A10 的一致性。使用 A5-A10 偏差为 A5 开发新的纤维蛋白原替代阈值；这与现有的 A10 阈值进行了临床比较。
FIBTEM A5 与 A10 显示出极好的一致性。组内相关系数=0.972（95%置信区间[CI] 0.969-0.974）。A5 到 A10 的偏差为 -1.49（95%CI 1.43-1.56）mm。19.34%的患者符合当地 A10 <11mm 的原始阈值；19.28%的患者符合新的、偏差调整后的 A5 <10mm 的阈值。
ROTEM FIBTEM A5 可可靠预测创伤中的 A10。这进一步验证了 A5 结果的使用优于 A10，可在创伤患者的时间关键复苏中更快地做出决策。在创伤患者中，A10 阈值的 -1 修正可能是合适的。
