The Role of Rotation Thromboelastometry in Early Prediction of Massive Transfusion

• DOI: 10.1097/ta.0b013e3181faaa25
• Publication Date: 2010-12-11T07:29:24Z
• Authors: Harald Leemann; Thomas Lustenberger; Peep Talving; Leslie Kobayashi; Marko Bukur; Mirko Brenni; Martin Brüesch; Donat R. Spahn; Marius J. B. Keel
• Keywords: Thromboelastometry

Early prediction of massive transfusion (MT) is critical in the management severely injured trauma patients. Variables available early after injury including physiologic, laboratory, and rotation thromboelastometric (ROTEM) parameters were evaluated as predictors for need MT.After Institutional Review Board approval, we retrospectively reviewed a cohort patients (Injury Severity Score ≥ 16) admitted to Level I center with ROTEM measurements on hospital admission during 1-year study period. Patients isolated head (Abbreviated Injury Scale 3 Abbreviated chest, abdomen, extremity < 3) penetrating mechanism excluded. who received MT (≥ 10 units packed red blood cell within 24 hours admission) compared did not. independently associated identified using stepwise logistic regression.A total 53 met inclusion criteria. Of these, 18 (34.0%) 35 (66.0%) Massively transfused had significantly lower baseline hemoglobin values (7.9 g/dL ± 0.4 vs. 11.4 g/dL; p 0.001) trend toward higher lactate (4.8 mmol/L 0.8 3.0 0.3 mmol/L; = 0.056) base deficit (5.9 1.1 3.6 0.6 0.052). Mean international normalized ratio (1.46 0.07 1.22 0.05; partial thromboplastin times (42.4 seconds 5.0 29.7 1.8 seconds; receiving altered non-MT An increase clot formation time (471.3 169.9 178.1 19.9 0.001), shortening maximum firmness (37.5 mm 2.9 50.7 1.4 mm; amplitude at all points (10/20/30 minutes) observed massively included level ≤ an abnormal value (area under receiver operator characteristic curve: 0.831 [95% confidence interval: 0.719-0.942; 0.001]).Hemoglobin cloth measured by thromboelastometry reliably predict MT. Prospective validation effectiveness guide practice warranted.