• Christiaan N Mamczak, Megan Maloney, Braxton Fritz, Bryan Boyer, Scott Thomas, Ed Evans, Victoria A Ploplis, Francis J Castellino, Jonathon McCollester, and Mark Walsh.
• *Beacon Orthopaedic Trauma Surgery, South Bend, IN; †Memorial Hospital of South Bend, South Bend, IN; ‡Indiana University School of Medicine, South Bend, IN; §Self Regional Hospital, Greenwood, SC; ‖General and Vascular Surgery PC, South Bend, IN; and ¶W. M. Keck Center for Transgene Research, University of Notre Dame, Notre Dame, IN.
• J Orthop Trauma. 2016 Jun 1; 30 (6): 299-305.

ObjectivesTo describe the adjunctive use of thromboelastography (TEG) in directing initial blood component therapy resuscitation of patients with polytrauma with acute pelvic/acetabular fractures.DesignRetrospective cohort review.SettingLevel-2 trauma center.PatientsForty adult trauma activations with acute pelvic and/or acetabular fractures were treated with standard fracture care and TEG with adjuvant platelet mapping (TEG/PM) analysis to guide their initial 24-hour resuscitation.InterventionTEG with PM provided goal-directed hemostatic resuscitation using component blood products and an established hospital transfusion protocol. Transfusions were triggered by abnormal TEG/PM results and/or the presence of active hemorrhage, persistent hemorrhagic shock, and abnormal base deficit levels.Main Outcome MeasurementThe correction of trauma-induced coagulopathy was determined by the return of a normal TEG/PM tracing. The numbers of component blood products transfused in the first 24 hours using TEG/PM were calculated. Subgroup analysis of transfusion requirements and differences between pelvic ring and acetabular fracture patterns were determined.ResultsMore than 90% of patients received a transfusion of at least 1 blood product with 84% of transfusions occurring within 6 hours of admission. TEG/PM-guided resuscitation yielded greater volumes of platelets and packed red blood cells (PRBCs) versus fresh frozen plasma (FFP) (P = 0.018) with an average transfusion ratio of 2.5:1:2.8 (PRBC:FFP:platelet). There was a trend toward greater transfusion requirements in combined injuries versus pelvic ring or acetabular fractures (P = 0.08).ConclusionTEG with PM is a valuable adjunct to guide the acute phase of resuscitation in patients with polytrauma with pelvic injuries because it allows a real-time assessment of the coagulation status. The routine use of TEG/PM may result in transfusion ratios of blood products different from those of the current empiric 1:1:1 guidelines.Level Of EvidenceTherapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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