Authors (including presenting author) :
Ching KC(1), Tsui KL(2), Ha PK(1), Leung CY(1)
Affiliation :
(1) Accident and Emergency Department, Tuen Mun Hospital, (2) Accident and Emergency Department, Pok Oi Hospital
Introduction :
Hemostatic resuscitation avoids trauma induced coagulopathy by early use of blood products via Massive Transfusion Guideline. MTG involves large volume of blood products and is laden with transfusion-related risks.
Goal-directed patient blood management via viscoelastic hemostatic essay (VHA) provides real time guidance to blood transfusion. VHA has been used in liver, cardiothoracic and obstetric surgeries. VHA in trauma is gaining popularity internationally as it reduces blood product use and corrects TIC.
Objectives :
Rotational Thromboelastography (ROTEM) is a POCT VHA that measures the viscoelastic properties of clot formation. Conventional clotting tests do not correlate with clinical coagulopathy, takes longer time, and cannot provide real time guidance.
TMH is the first to adopt hybrid MTG-ROTEM model since 3/2021. Data has since been collected to assess clinical outcomes and the amount of blood product use.
Methodology :
After MTG is activated, blood sample is sent for ROTEM analysis. Hypotensive patients are initially resuscitated with blood products in conventional fixed ratio approach. When ROTEM result is ready, blood product is given according to predetermined algorithm. ROTEM can be repeated every 30 minutes until definitive hemostasis is achieved.
All MTG cases in 2020 were reviewed and compared to MTG-ROTEM cases from 3-12/2021.
Result & Outcome :
There are 10 cases with ROTEM activation. The number of ROTEM done ranged from 1-7.
Of the 10 cases, 6 were compiled with the MTG-ROTEM had extensive blood loss with an average replacement of 10.8u RBC; 6.7u FFP and 6u PLT. On average, ROTEM was done 3.2 times. The average ISS, RTS and Ps were 45.7, 3.95 and 0.24. The 24-hour mortality and Day-30 mortality were 33.3% and 66.7%.
Of the 22 MTG cases in 2020, the average transfused RBC, FFP and Plt were 13.7u, 9.9u and 6.6u respectively in 2020. The average ISS, RTS and Ps were 33.7, 6.5 and 0.69. The 24-hour mortality and Day-30 mortality were 13.6% and 31.8%.
Since ROTEM, a reduction in blood product use was noted. Comparing the 6 massive bleeding ROTEM patients with 2020 MTG data, the average reduction in RBC, FFP and PLT were 21%, 32% and 9%.
Limited number of ROTEM cases renders interpretation difficult, but the observed reduction in blood product aligns with international data. The worsened 24-hour and Day-30 mortality in the ROTEM group could be explained by more severe injury scores and not be attributed solely to the use of ROTEM.
