Abstract
Rotational thromboelastometry is recommended to guide haemostatic therapy in trauma-related coagulopathy. In the case of unsuccessful venepuncture, intraosseous access allows immediate administration of drugs and volume replacement. Feasibility of rotational thromboelastometry from intraosseous blood has not yet been investigated in humans. We performed rotational thromboelastometry and standard coagulation assays from intraosseous and intravenous blood samples in 19 volunteers and 4 patients undergoing general anaesthesia. Intraosseous access was performed either at the tibial bone or the proximal humerus. We observed visible clotting in the majority of the intraosseous samples. Only 13% of the probes allowed realization of rotational thromboelastometry. ROTEM parameters are reported as follows: shorter median clotting time (CT) in EXTEM, INTEM, and APTEM (53 vs. 68 s; 140 vs. 154 s; 54 vs. 62.5 s) and smaller median maximal clot firmness (MCF) in EXTEM and APTEM (56 vs. 63 mm; 55 vs. 62 mm) in intraosseous samples. We found no relevant differences in median MCF values in FIBTEM and INTEM (12 vs. 13 mm; 60 vs. 59 mm). Given the difficulties we faced during IO blood sampling in a study setting, we advise against ROTEM measurements out of IO blood for guidance of procoagulant therapy in emergency situations.
Highlights
Establishing intravenous (IV) access can be challenging in severely injured patients
It seems appropriate to investigate the reliability of rotational thromboelastometry (ROTEM) parameters determined in IO blood to allow a target-oriented administration of procoagulant drugs in patients who have only IO access
Conflicting results exist for activated partial thromboplastin time (aPTT): while we found a good correlation, clinically relevant differences were found in the porcine model
Summary
Establishing intravenous (IV) access can be challenging in severely injured patients. Despite declining incidence of trauma-induced coagulopathy, severe bleeding still affects mortality and requires immediate intervention. Despite declining incidence of trauma-induced coagulopathy, severe bleeding still affects mortality and requires immediate intervention2,3 Viscoelastic tests such as rotational thromboelastometry (ROTEM) allow a goal-directed, individualized approach to haemostatic therapy in trauma patients. It seems appropriate to investigate the reliability of ROTEM parameters determined in IO blood to allow a target-oriented administration of procoagulant drugs in patients who have only IO access. A recent study by Strandberg et al investigated the feasibility of measuring coagulation parameters including ROTEM from IO blood in a swine model. The aim of our study was to compare ROTEM parameters determined in blood from IO and venous access in healthy individuals and patients without coagulopathy
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