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https://www.readbyqxmd.com/read/28302286/viscoelastic-hemostatic-assays-in-the-management-of-the-pediatric-trauma-patient
#1
Christine M Leeper, Barbara A Gaines
Viscoelastic hemostatic assays (VHA), such as TEG and ROTEM, are whole blood tests that depict functional coagulation both numerically and graphically. The development of rapid VHA technology, which allows for the first data points to result within minutes of test initiation, has increased the utility of these tests in the treatment of trauma patients. Both adult and pediatric centers have integrated VHAs into trauma resuscitation and transfusion protocols. Literature regarding the use of VHAs for injured children is limited...
February 2017: Seminars in Pediatric Surgery
https://www.readbyqxmd.com/read/28292321/prothrombin-time-is-predictive-of-low-plasma-prothrombin-concentration-and-clinical-outcome-in-patients-with-trauma-hemorrhage-analyses-of-prospective-observational-cohort-studies
#2
Clare A Balendran, Ann Lövgren, Kenny M Hansson, Karin Nelander, Marita Olsson, Karin J Johansson, Karim Brohi, Dietmar Fries, Anders Berggren
BACKGROUND: Fibrinogen and prothrombin have been suggested to become rate limiting in trauma associated coagulopathy. Administration of fibrinogen is now recommended, however, the importance of prothrombin to patient outcome is unknown. METHODS: We have utilized two trauma patient databases (database 1 n = 358 and database 2 n = 331) to investigate the relationship of plasma prothrombin concentration on clinical outcome and coagulation status. Database 1 has been used to assess the relationship of plasma prothrombin to administered packed red blood cells (PRBC), clinical outcome and coagulation biomarkers (Prothrombin Time (PT), ROTEM EXTEM Coagulation Time (CT) and Maximum Clot Firmness (MCF))...
March 14, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/28257393/potential-role-of-platelet-leukocyte-aggregation-in-trauma-induced-coagulopathy-ex-vivo-findings
#3
Johannes Zipperle, Katrin Altenburger, Martin Ponschab, Christoph J Schlimp, Andreas Spittler, Soheyl Bahrami, Heinz Redl, Herbert Schöchl
BACKGROUND: Platelet dysfunction has been identified as an important contributor of trauma-induced coagulopathy (TIC) but the underlying mechanism still remains to be elucidated. Trauma-associated pro-inflammatory stimuli strongly activate leukocytes, which in turn bind activated platelets. Therefore, we investigated the role of platelet-leukocyte aggregation (PLA) as a potential feature of trauma-induced platelet dysfunction. METHODS: Whole blood from 10 healthy donors was exposed to selective and collective platelet and leukocyte agonists in order to simulate differential states of activation...
March 2, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28240645/point-of-care-monitoring-for-the-management-of-trauma-induced-bleeding
#4
Alexander A Hanke, Hauke Horstmann, Michaela Wilhelmi
PURPOSE OF REVIEW: Knowledge of trauma-induced coagulopathy has been grown in the past and point-of-care suitable devices for coagulation testing have been introduced. Methodology and clinical application of different systems for point-of-care coagulation monitoring are shown with a focus on thrombelastography as measured by TEG, rotational thromboelastometry as measured by ROTEM and impedance aggregometry as measured by the multiplate analyser and ROTEM platelet. RECENT FINDINGS: Two different methods for point-of-care coagulation assessment are available: viscoelastic tests (ROTEM, TEG) and impedance aggregometry...
April 2017: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/28219085/fibrinolysis-in-trauma-myth-reality-or-something-in-between
#5
Mark Walsh, Jacob Shreve, Scott Thomas, Ernest Moore, Hunter Moore, Daniel Hake, Tim Pohlman, Patrick Davis, Victoria Ploplis, Andres Piscoya, Julie Wegner, John Bryant, Anton Crepinsek, James Lantry, Forest Sheppard, Francis Castellino
The emphasis on fibrinolysis as an important contributor to trauma-induced coagulopathy (TIC) has led to a debate regarding the relative clinical significance of fibrinolysis in the setting of trauma. The debate has centered on two camps. The one camp defines fibrinolysis in trauma by standard coagulation tests as well as fibrin split products, D-dimers, and plasmin/antiplasmin levels. This camp favors a more liberal use of tranexamic acid and attributes more significance to hyperfibrinolysis in TIC. The other camp favors a definition of fibrinolysis based on the viscoelastic tests (VET), rotational thromboelastometry (ROTEM), and thromboelastography (TEG)...
March 2017: Seminars in Thrombosis and Hemostasis
https://www.readbyqxmd.com/read/28129263/tissue-injury-suppresses-fibrinolysis-after-hemorrhagic-shock-in-nonhuman-primates-rhesus-macaque
#6
Antoni R Macko, Hunter B Moore, Andrew P Cap, M Adam Meledeo, Ernest E Moore, Forest R Sheppard
BACKGROUND: Hypoperfusion is associated with hyperfibrinolysis and early death from exsanguination, whereas tissue trauma is associated with hypofibrinolysis and delayed death from organ failure. We sought to elucidate the effects of injury patterns on fibrinolysis phenotypes using a nonhuman primate (NHP) model. METHODS: NHPs were randomized to three injury groups (n = 8/group): 60 minutes severe pressure-targeted controlled hemorrhagic shock (HS); HS + soft tissue injury (HS+); or HS + soft tissue injury + femur fracture (HS++)...
April 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28093623/what-factor-within-the-japanese-association-for-acute-medicine-jaam-disseminated-intravascular-coagulation-dic-criteria-is-most-strongly-correlated-with-trauma-induced-dic-a-retrospective-study-using-thromboelastometry-in-a-single-center-in-japan
#7
H Koami, Y Sakamoto, K C Yamada, T Matsuda, J Nishi, K Nakayama, R Sakurai, M Ohta, H Imahase, M Yahata, M Umeka, T Miike, F Nagashima, T Iwamura, S Inoue
PURPOSE: The diagnostic criteria for disseminated intravascular coagulation (DIC) established by the Japanese Association for Acute Medicine (JAAM) is able to diagnose DIC accurately and promptly. The aim of this retrospective study is to evaluate the degree of association between each parameter of JAAM DIC criteria and the diagnosis of trauma induced DIC (T-DIC) utilizing thromboelastometry (ROTEM). METHODS: Trauma patients transported to our hospital with ROTEM performed in the emergency department between January 2013 and December 2015 were enrolled in this study...
January 16, 2017: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
https://www.readbyqxmd.com/read/27994260/a-case-of-successful-thromboelastographic-guided-resuscitation-after-postpartum-hemorrhage-and-cardiac-arrest
#8
M Hurwich, D Zimmer, E Guerra, E Evans, T Shire, M Abernathy, J T Shreve, G R Kolettis, M T McCurdy, F J Castellino, M Walsh
Amniotic fluid embolism (AFE) is an unusual cause of life threatening peri partum hemorrhage (PPH). AFE resuscitation is often associated with renal and respiratory insufficiency, and a coagulopathy similar to disseminated intravascular coagulation (DIC). Resuscitation requires immediate recognition and limited use of crystalloid. We present a case of PPH caused by AFE with resultant cardiac arrest, renal and respiratory failure, and DIC-like coagulopathy, whose successful resuscitation was guided by perfusionist-directed serial thromboelastography (TEG)...
December 2016: Journal of Extra-corporeal Technology
https://www.readbyqxmd.com/read/27941590/traumatic-hemothorax-blood-contains-elevated-levels-of-microparticles-that-are-prothrombotic-but-inhibit-platelet-aggregation
#9
Thomas A Mitchell, Maryanne C Herzig, Chriselda G Fedyk, Marc A Salhanick, Aaron T Henderson, Bijaya K Parida, Nicolas J Prat, Daniel L Dent, Martin G Schwacha, Andrew P Cap
OBJECTIVES: Autotransfusion of shed blood from traumatic hemothorax is an attractive option for resuscitation of trauma patients in austere environments. However, previous analyses revealed that shed hemothorax (HX) blood is defibrinated, thrombocytopenic, and contains elevated levels of D-dimer. Mixing studies with normal pooled plasma demonstrated hypercoagulability, evoking concern for potentiation of acute traumatic coagulopathy. We hypothesized that induction of coagulopathic changes by shed HX blood may be due to increases in cellular microparticles (MP) and that these may also affect recipient platelet function...
December 9, 2016: Shock
https://www.readbyqxmd.com/read/27894492/management-of-trauma-induced-coagulopathy-with-thrombelastography
#10
REVIEW
Eduardo Gonzalez, Ernest E Moore, Hunter B Moore
Viscoelastic assays, such as thrombelastography (TEG) and rotational thrombelastometry (ROTEM), have emerged as point-of-care tools that can guide the hemostatic resuscitation of bleeding injured patients. This article describes the role of TEG in contemporary trauma care by explaining this assay's methodology, clinical applications, and result interpretation through description of supporting studies to provide the reader with an evidence-based user's guide. Although TEG and ROTEM are assays based on the same viscoelastic principle, this article is focused on data supporting the use of TEG in trauma, because it is available in trauma centers in North America; ROTEM is mostly available in Europe...
January 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/27814502/psychological-resilience-in-u-s-military-veterans-a-2-year-nationally-representative-prospective-cohort-study
#11
Kayla Isaacs, Natalie P Mota, Jack Tsai, Ilan Harpaz-Rotem, Joan M Cook, Paul D Kirwin, John H Krystal, Steven M Southwick, Robert H Pietrzak
Although many cross-sectional studies have examined the correlates of psychological resilience in U.S. military veterans, few longitudinal studies have identified long-term predictors of resilience in this population. The current prospective cohort study utilized data from a nationally representative sample of 2157 U.S. military veterans who completed web-based surveys in two waves (2011 and 2013) as part of the National Health and Resilience in Veterans Study (NHRVS). Cluster analysis of cumulative lifetime exposure to potentially traumatic events and Wave 2 measures of current symptoms of posttraumatic stress, major depressive, and generalized anxiety disorders was performed to characterize different profiles of current trauma-related psychological symptoms...
October 22, 2016: Journal of Psychiatric Research
https://www.readbyqxmd.com/read/27724970/the-pre-hospital-administration-of-tranexamic-acid-to-patients-with-multiple-injuries-and-its-effects-on-rotational-thrombelastometry-a-prospective-observational-study-in-pre-hospital-emergency-medicine
#12
Nils Kunze-Szikszay, Lennart A Krack, Pauline Wildenauer, Saskia Wand, Tim Heyne, Karoline Walliser, Christopher Spering, Martin Bauer, Michael Quintel, Markus Roessler
BACKGROUND: Hyperfibrinolysis (HF) is a major contributor to coagulopathy and mortality in trauma patients. This study investigated (i) the rate of HF during the pre-hospital management of patients with multiple injuries and (ii) the effects of pre-hospital tranexamic acid (TxA) administration on the coagulation system. METHODS: From 27 trauma patients with pre-hospital an estimated injury severity score (ISS) ≥16 points blood was obtained at the scene and on admission to the emergency department (ED)...
October 10, 2016: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/27716278/a-systematic-review-on-the-rotational-thrombelastometry-rotem%C3%A2-values-for-the-diagnosis-of-coagulopathy-prediction-and-guidance-of-blood-transfusion-and-prediction-of-mortality-in-trauma-patients
#13
REVIEW
Precilla V Veigas, Jeannie Callum, Sandro Rizoli, Bartolomeu Nascimento, Luis Teodoro da Luz
INTRODUCTION: Viscoelastic assays have been promoted as an improvement over traditional coagulation tests in the management of trauma patients. Rotational thromboelastometry (ROTEM®) has been used to diagnose coagulopathy and guide hemostatic therapy in trauma. This systematic review of clinical studies in trauma investigates the ROTEM® parameters thresholds used for the diagnosing coagulopathy, predicting and guiding transfusion and predicting mortality. METHODS: Systematic literature search was performed using MEDLINE, EMBASE and Cochrane databases...
October 3, 2016: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/27658942/algorithm-for-activation-of-coagulation-support-treatment-in-multiple-injured-patients-cohort-study
#14
D Brilej, D Stropnik, R Lefering, R Komadina
BACKGROUND: Early recognition and management of trauma related coagulopathy improves the outcome. Trauma facilities should implement an algorithm to identify the bleeding trauma patient with coagulopathy. OBJECTIVE: The scope of the paper is to identify the indicators of early coagulopathy and to optimize the indications for thromboelastometry and coagulation support. DESIGN: Cohort study based on data from trauma registry. SETTING: Data of 493 major trauma patients treated in GH Celje from 2006 to 2014 were included into The TraumaRegister DGU(®) (TR-DGU)...
September 22, 2016: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
https://www.readbyqxmd.com/read/27638555/-uncritical-use-of-tranexamic-acid-in-trauma-patients-do-no-further-harm
#15
M Maegele
Based upon the results of CRASH-2, early administration of antifibrinolytic tranexamic acid (TXA) is recommended in bleeding trauma patients or trauma patients presumed to bleed. Many trauma centers and emergency medical services have adopted this practice into their routine algorithms. The pitfalls of CRASH-2 have been discussed in the literature, but the positive effects could sometimes not be reproduced in follow-up studies. The mechanism of action of TXA in trauma is still not clear and major knowledge gaps with TXA in the context of trauma have been identified...
November 2016: Der Unfallchirurg
https://www.readbyqxmd.com/read/27616611/-use-of-thrombelastography-to-guide-posttraumatic-hemostatic-therapy-more-coagulation-factor-concentrates-and-less-allogenic-blood-transfusion
#16
J S David, E Imhoff, S Parat, L Augey, M-O Geay-Baillat, P Incagnoli, K Tazarourte
Viscoelastic technics are used for 10 years and include the ROTEM(®) and the TEG(®). These devices that exploit the viscoelastic properties of the clotting blood, allow a rapid and global analysis of the haemostatic process taking into account all the process interfering with haemostasis such as inflammation. It has been shown that the use of these technics in clinical situations such as trauma, postpartum haemorrhage, gastrointestinal bleeding or cardiac surgery may reduce the need for blood product, the cost and perhaps may improve the outcome of the patients...
November 2016: Transfusion Clinique et Biologique: Journal de la Société Française de Transfusion Sanguine
https://www.readbyqxmd.com/read/27606964/targeting-blood-products-transfusion-in-trauma-what-is-the-role-of-thromboelastography
#17
Samy Figueiredo, Audrey Tantot, Jacques Duranteau
Viscoelastic hemostatic assays (VHAs), mainly thromboelastography (TEG) and the rotational thromboelastometry (ROTEM), provide global information on clot formation and dissolution at patient bedside, allowing fast identification of coagulation disorders. In trauma patients, VHAs are able to predict massive transfusion and mortality. These devices might also be used for applying targeted administration of procoagulant factors (e.g. fibrinogen concentrate) as an alternative to or in addition to using predefined fixed ratios of red blood cells: platelets: fresh frozen plasma/cryoprecipitate...
November 2016: Minerva Anestesiologica
https://www.readbyqxmd.com/read/27515056/the-confusion-continues-results-from-an-american-association-for-the-surgery-of-trauma-survey-on-massive-transfusion-practices-among-united-states-trauma-centers
#18
Eric Etchill, Jason Sperry, Brian Zuckerbraun, Louis Alarcon, Joshua Brown, Kevin Schuster, Lewis Kaplan, Greta Piper, Andrew Peitzman, Matthew D Neal
BACKGROUND: Massive transfusion practices have undergone several recent developments. We sought to examine institutional practices guiding hemostatic resuscitation in the setting of massive hemorrhage. STUDY DESIGN AND METHODS: A 37-question online survey was sent to American Association for the Surgery of Trauma members. RESULTS: A total of 191 surgeons from 125 institutions completed the survey. Level I and II centers composed 70 and 18% of responding sites, respectively...
October 2016: Transfusion
https://www.readbyqxmd.com/read/27506588/in-vitro-effects-of-different-sources-of-fibrinogen-supplementation-on-clot-initiation-and-stability-in-a-model-of-dilutional-coagulopathy
#19
N Schäfer, A Driessen, U Bauerfeind, M Fröhlich, J Ofir, E K Stürmer, M Maegele
OBJECTIVES: To analyse which fibrinogen source may improve coagulation using an in vitro 33% dilutional coagulopathy model. BACKGROUND: Uncritical volume resuscitation in the context of trauma haemorrhage contributes to the iatrogenic arm of the acute trauma-induced coagulopathy through dilution and depletion of coagulation factors, with fibrinogen reaching critical levels first. MATERIALS AND METHODS: By using an experimental model of 33% dilutional coagulopathy, we have analysed which fibrinogen source may exert superior effects on improving haemocoagulative capacities and correcting depleted fibrinogen levels...
October 2016: Transfusion Medicine
https://www.readbyqxmd.com/read/27495106/the-thromboelastometric-discrepancy-between-septic-and-trauma-induced-disseminated-intravascular-coagulation-diagnosed-by-the-scoring-system-from-the-japanese-association-for-acute-medicine
#20
COMPARATIVE STUDY
Hiroyuki Koami, Yuichiro Sakamoto, Ryota Sakurai, Miho Ohta, Hisashi Imahase, Mayuko Yahata, Mitsuru Umeka, Toru Miike, Futoshi Nagashima, Takashi Iwamura, Kosuke Chris Yamada, Satoshi Inoue
The aim of this study is to evaluate the hematological differences between septic and traumatic disseminated intravascular coagulation (DIC) using the rotational thromboelastometry (ROTEM).This retrospective study includes all sepsis or severe trauma patients transported to our emergency department who underwent ROTEM from 2013 to 2014. All patients were divided into 2 groups based on the presence of DIC diagnosed by the Japanese Association for Acute Medicine (JAAM) DIC score. We statistically analyzed the demographics, clinical characteristics, laboratory data, ROTEM findings (EXTEM and FIBTEM), and outcome...
August 2016: Medicine (Baltimore)
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