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

Campbell, Don; Wake, Elizabeth; Walters, Kerin; Ho, Debbie; Keijzers, Gerben; Wullschleger, Martin; Winearls, James

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.

AUSTRALIA; INTENSIVE care units; HOSPITAL emergency services; INFORMATION storage & retrieval systems; MEDICAL databases; SCIENTIFIC observation; BLOOD transfusion; POINT-of-care testing; TRAUMA centers; BLOOD plasma; PATIENTS; BLOOD coagulation; RETROSPECTIVE studies; HOSPITAL admission & discharge; EMERGENCY medical services; CLINICAL medicine; FIBRINOGEN; BLOOD coagulation disorders; WOUNDS & injuries; HEMOSTATICS; BIOLOGICAL assay; RED blood cell transfusion; HEMORRHAGE

Emergency Medicine Australasia, 2021, Vol 33, Issue 3, p457

1742-6731

Academic Journal

10.1111/1742-6723.13643