Implementation of point-of-care ROTEM® into a trauma major haemorrhage protocol: A before and after study

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Campbell, D
Wake, E
Walters, K
Ho, D
Keijzers, G
Wullschleger, M
Winearls, J
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Objective: The 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. Methods: This 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. Results: Packed 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. Conclusion: Although 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.

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Emergency Medicine Australasia

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Campbell, D; Wake, E; Walters, K; Ho, D; Keijzers, G; Wullschleger, M; Winearls, J, Implementation of point-of-care ROTEM® into a trauma major haemorrhage protocol: A before and after study, Emergency Medicine Australasia, 2020