title: Evaluation of coagulation stages of hemorrhaged swine: comparison of thromboelastography and rotational elastometry.
abstract: Thromboelastography (TEG) or rotational thromboelastometry (ROTEM) assesses blood viscoelastic properties and clotting kinetics that can be measured by Haemoscope TEG and Pentapharm ROTEM devices using slightly different methodologies. These devices were compared by measuring blood samples associated with various degrees of coagulopathy. Blood samples, collected from swine undergoing three types of severe injury and resuscitation protocol resulting in normal, hypercoagulopathy, and hypocoagulopathy, were assessed with TEG or ROTEM before the surgical procedures, and after injury, fluid resuscitation, and simulated hospital phase. Standard clotting parameters were compared by Student's t-test at a significance of a P value less than 0.05. Regression analysis indicated a positive correlation between TEG and ROTEM for reaction time (R), clotting rate (K), and maximum amplitude (Ma) parameters. With samples of normal coagulation, R (440 +/- 136 vs. 391 +/- 73 s), K (99 +/- 39 vs. 81 +/- 20 s), and Ma (74 +/- 4 vs. 69 +/- 5 mm) were higher, whereas (alpha) (68 +/- 8 vs. 75 +/- 3 mm) was lower with TEG than ROTEM, respectively; a P value is less than 0.05. The magnitude of changes from baseline in hypercoagulable or hypocoagulable samples due to level of injury was equivalent with TEG and ROTEM indicating comparable use of the instruments. However, when samples were extremely hypocoagulopathic due to resuscitation fluid, the TEG values could not be readily determined. Overall, TEG readings were higher than ROTEM readings; this disparity between the two instruments was attenuated with hypercoaguable samples. Both devices yielded similar information regarding the status of coagulation related to trauma. Because of operating characteristics, the same instrument should be used for monitoring the same patient or study.
authors.affiliation: Department of Trauma and Resuscitative Medicine, Naval Medical Research Center, Silver Spring, Maryland 20910-7500, USA.
authors.forename: Toshiki
authors.initials: T
authors.lastname: Tomori
authors.forename: Daniel
authors.initials: D
authors.lastname: Hupalo
authors.forename: Kohsuke
authors.initials: K
authors.lastname: Teranishi
authors.forename: Sarah
authors.initials: S
authors.lastname: Michaud
authors.forename: Mike
authors.initials: M
authors.lastname: Hammett
authors.forename: Daniel
authors.initials: D
authors.lastname: Freilich
authors.forename: Richard
authors.initials: R
authors.lastname: McCarron
authors.forename: Françoise
authors.initials: F
authors.lastname: Arnaud
mesh_terms: D000818:Animals; D001777:Blood Coagulation / Q000502:physiology*; D001778:Blood Coagulation Disorders / Q000097:blood*; D001780:Blood Coagulation Tests; D001930:Brain Injuries / Q000097:blood / Q000150:complications; D004548:Elasticity; D054459:Elasticity Imaging Techniques / Q000295:instrumentation; D005263:Femoral Artery / Q000293:injuries; D006454:Hemoglobins / Q000627:therapeutic use; D006470:Hemorrhage / Q000097:blood* / Q000209:etiology / Q000628:therapy; D008099:Liver / Q000293:injuries; D010952:Plasma Substitutes / Q000627:therapeutic use; D011517:Prothrombin Time; D012151:Resuscitation / Q000379:methods*; D012771:Shock, Hemorrhagic / Q000097:blood / Q000209:etiology / Q000628:therapy; D034421:Sus scrofa / Q000097:blood*; D013552:Swine; D013916:Thrombelastography / Q000295:instrumentation; D019851:Thrombophilia / Q000097:blood / Q000209:etiology; D014783:Viscosity
chemical_list: D006454:Hemoglobins; D010952:Plasma Substitutes; C096798:HBOC 201