• Don Campbell, Elizabeth Wake, Kerin Walters, Debbie Ho, Gerben Keijzers, Martin Wullschleger, and James Winearls.
• Trauma Service, Gold Coast University Hospital, Gold Coast, Queensland, Australia.
• Emerg Med Australas. 2021 Jun 1; 33 (3): 457464457-464.

ObjectiveThe aim of the present study was to assess transfusion practices with the implementation of a targeted viscoelastic haemostatic assay (VHA) (ROTEM®) guided coagulation management programme into a major haemorrhage protocol for trauma patients requiring ICU admission, starting from time of arrival in the ED.MethodsThis retrospective observational study was conducted in a major trauma centre in Australia. One hundred and sixty-two trauma patients admitted to the ICU between January 2013 and December 2015 with an Injury Severity Score ≥12 and who received blood products were included: 37 in the pre-group, 48 during implementation and 77 in post-group. The primary outcome was blood and blood product administration amounts.ResultsPacked red blood cell transfusion amounts did not significantly change post introduction of the ROTEM®. There was a significant increase in fibrinogen replacement between the pre- and post-groups (P < 0.001), accompanied by a reduction in the use of fresh frozen plasma (P < 0.001) and prothrombinex (P < 0.001). Platelet usage in the post-group was higher but not reaching statistical significance (P  = 0.051). Post-implementation point-of-care ROTEM® testing was able to be performed in the ED in 94.8% of cases.ConclusionAlthough there was no overall reduction of packed red blood cell usage, a change in the pattern of administration of other blood products was observed with the implementation of a targeted VHA (ROTEM®) guided coagulation management programme. Larger studies are needed to further define the role of early VHA testing to guide correction of trauma-induced coagulopathy and the effect on clinical outcomes.© 2020 Australasian College for Emergency Medicine.

3 keywords...

hide…