FIBTEM provides early prediction of massive transfusion in trauma

Herbert Schochl,Kenji Inaba,Ulrike Nienaber,Wolfgang Voelckel,Cristina Solomon,Henrik Fischer,Bryan Cotton

doi:10.1186/cc10539

Abstract

IntroductionPrediction of massive transfusion (MT) among trauma patients is difficult in the early phase of trauma management. Whole-blood thromboelastometry (ROTEM®) tests provide immediate information about the coagulation status of acute bleeding trauma patients. We investigated their value for early prediction of MT.MethodsThis retrospective study included patients admitted to the AUVA Trauma Centre, Salzburg, Austria, with an injury severity score ≥16, from whom blood samples were taken immediately upon admission to the emergency room (ER). ROTEM® analyses (extrinsically-activated test with tissue factor (EXTEM), intrinsically-activated test using ellagic acid (INTEM) and fibrin-based extrinsically activated test with tissue factor and the platelet inhibitor cytochalasin D (FIBTEM) tests) were performed. We divided patients into two groups: massive transfusion (MT, those who received ≥10 units red blood cell concentrate within 24 hours of admission) and non-MT (those who received 0 to 9 units).ResultsOf 323 patients included in this study (78.9% male; median age 44 years), 78 were included in the MT group and 245 in the non-MT group. The median injury severity score upon admission to the ER was significantly higher in the MT group than in the non-MT group (42 vs 27, P < 0.0001). EXTEM and INTEM clotting time and clot formation time were significantly prolonged and maximum clot firmness (MCF) was significantly lower in the MT group versus the non-MT group (P < 0.0001 for all comparisons). Of patients admitted with FIBTEM MCF 0 to 3 mm, 85% received MT. The best predictive values for MT were provided by hemoglobin and Quick value (area under receiver operating curve: 0.87 for both parameters). Similarly high predictive values were observed for FIBTEM MCF (0.84) and FIBTEM A10 (clot amplitude at 10 minutes; 0.83).ConclusionsFIBTEM A10 and FIBTEM MCF provided similar predictive values for massive transfusion in trauma patients to the most predictive laboratory parameters. Prospective studies are needed to confirm these findings.

Highlights

Prediction of massive transfusion (MT) among trauma patients is difficult in the early phase of trauma management
The primary aim of this study was to assess the predictive value of ROTEM® parameters for MT among trauma patients treated with coagulation factor concentrates, with ROTEM® analyses performed on samples taken immediately upon admission to the emergency room (ER)
Patients in the MT group had significantly lower blood pressure (BP), higher heart rate (HR), and higher injury severity score (ISS) values upon admission to the ER compared with patients in the non-MT group

Summary

Introduction

Prediction of massive transfusion (MT) among trauma patients is difficult in the early phase of trauma management. Whole-blood thromboelastometry (ROTEM®) tests provide immediate information about the coagulation status of acute bleeding trauma patients. We investigated their value for early prediction of MT. We hypothesized whether ROTEM® tests could potentially help identify patients who are prone to TIC and MT immediately upon arrival at the trauma centre. An investigation by Leemann et al was designed to answer the same question [5], in that study coagulation therapy was based on allogeneic blood components. In our centre we primarily use coagulation factor concentrates, which reduces transfusion of allogeneic blood products [21] and, changes the basis for predicting MT

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