Abstract
Hemorrhage and traumatic coagulopathyis are major causes of early death in multiply injured patients. Thrombelastography (TEG) seems to be a fast and accurate coagulation test in trauma care. We suggest that multiply injured trauma patients would benefit the most from an early assessment of coagulation by TEG, mainly RapidTEG, to detect an acute traumatic coagulopathy and especially primary fibrinolysis, which is related with high mortality. This review gives an overview on TEG and its clinical applications.
Highlights
Hemorrhage is a major cause of early death in multiply injured patients
The pathomechanism of acute traumatic coagulopathy is extensively reviewed by Hess et al [3] 25% of major trauma patients suffer from coagulopathy at admission to the hospital, and its presence is associated with a fourfold increase in mortality [2]
This is the reason why trauma studies focusing on hemodynamics, hemorrhage control, and coagulopathy are performed with animal models
Summary
One of the reasons of uncontrolled hemorrhage may be acute traumatic coagulopathy It has been first discussed by Brohi and colleagues, and it is thought to be induced by trauma and hypoperfusion [1, 2]. The acute traumatic coagulopathy may occur in absence of acute bleeding, for example, due to massive blunt injury and hypothermia. This pattern is typical for our patients population in a Level 1 trauma center in Switzerland, where we face mainly car accidents and injuries related to outdoor sports (skiing, climbing, base jumping, avalanches, etc.). The search for appropriate point of care devices in trauma care brought thrombelastography (TEG) back in focus in 1997 by Kaufmann et al after the technique had been used for years in cardiac and liver surgery [7, 8]
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