Rotational thromboelastometry (ROTEM) is a blood test used to measure in vitro clot strength as a surrogate for a patient’s ability to form clots in vivo. This provides information about induction, formation, and clot lysis, allowing goal-directed transfusion therapy for specific hemostatic needs. We sought to evaluate the effect of ROTEM-guided transfusion on blood product usage and in-hospital mortality among patients with a traumatic injury. This was a single-center observational cohort analysis of emergency department patients in a Level 1 trauma center. We compared blood usage in trauma patients in whom ratio-based massive hemorrhage protocols were activated in the twelve months before the introduction of ROTEM (pre-ROTEM group) to the twelve months following the introduction of ROTEM (ROTEM-period group). ROTEM was implemented in this center in November 2016. The ROTEM device allowed clinicians to make real-time decisions about blood product therapy in resuscitation for trauma. The pre-ROTEM group contained 21 patients. Forty-three patients were included from the ROTEM-period, of whom 35 patients received ROTEM-guided resuscitation (81% compliance). The use of fibrinogen concentrate was significantly higher in the ROTEM-period group (pre-ROTEM mean 0.2 vs. ROTEM-period mean 0.8; p = 0.006). There was no significant difference in the number of units of red blood cells, platelets, cryoprecipitate, or fresh frozen plasma transfused between these groups. There was no significant difference in the mortality rate between the pre-ROTEM and ROTEM-period groups (33% vs. 19%; p = 0.22). The introduction of ROTEM-guided transfusion at this institution was associated with increased fibrinogen usage, but this did not impact mortality rates. There was no difference in the administration of red blood cell, fresh frozen plasma, platelet, and cryoprecipitate. Future research should focus on increased ROTEM compliance and optimizing ROTEM-guided transfusion to prevent blood product overuse among trauma patients.

中文翻译：

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旋转血栓弹力测定法引导创伤患者输血：单中心队列研究

旋转血栓弹力测定 (ROTEM) 是一种血液测试，用于测量体外凝块强度，作为患者体内形成凝块的能力的替代指标。这提供了有关诱导、形成和血栓溶解的信息，从而允许针对特定止血需求进行目标导向的输血治疗。我们试图评估 ROTEM 引导输血对创伤性损伤患者的血液制品使用和院内死亡率的影响。这是对 1 级创伤中心急诊科患者的单中心观察队列分析。我们比较了在引入 ROTEM 之前 12 个月（ROTEM 前组）和引入 ROTEM 后 12 个月（ROTEM 期组）激活基于比率的大出血方案的创伤患者的血液使用情况。ROTEM 于 2016 年 11 月在该中心实施。ROTEM 设备使临床医生能够实时决定创伤复苏中的血液制品治疗。ROTEM 前组包含 21 名患者。ROTEM 期间纳入了 43 名患者，其中 35 名患者接受了 ROTEM 指导的复苏（81% 的依从性）。ROTEM 期间组中纤维蛋白原浓缩物的使用显着较高（ROTEM 前平均值 0.2 对比 ROTEM 期间平均值 0.8；p = 0.006）。这些组之间输注的红细胞、血小板、冷沉淀或新鲜冰冻血浆的单位数量没有显着差异。ROTEM 前组和 ROTEM 期组之间的死亡率没有显着差异（33% vs. 19%；p = 0.22）。该机构引入 ROTEM 引导输血与纤维蛋白原使用量的增加有关，但这并没有影响死亡率。红细胞、新鲜冰冻血浆、血小板和冷沉淀的施用没有差异。未来的研究应集中于提高 ROTEM 依从性和优化 ROTEM 引导输血，以防止创伤患者过度使用血液制品。