Feasibility of using rotational thromboelastometry to assess coagulation status of combat casualties in a deployed setting.
BACKGROUND
Coagulopathy in trauma patients is currently defined by the results of standard laboratory tests (prothrombin time and activated partial thromboplastin time). These results offer little in the hemostatic resuscitation that occurs in the treatment of battlefield patients who receive massive transfusions. Thromboelastometry (TEM) is a technique that can offer rapid, near-patient testing of coagulation status.


METHODS
A prospective observational field study was performed in a deployed military setting to determine the feasibility of using TEM to assess the coagulation status of patients admitted to the emergency department and who subsequently received a massive transfusion.


RESULTS
TEM was performed on 31 patients, 25 were direct admissions to the emergency department, 19 of whom were enrolled into the massive transfusion protocol, and 60% were involved in a blast incident. Standard laboratory testing showed that 10% of all patients were coagulopathic on admission compared with 64% with an abnormal TEM trace (p = 0.0005). All patients had abnormal maximum clot firmness. The TEM amplitude at 10 minutes is associated with the subsequent development of abnormal maximum clot firmness. Two exemplar cases are discussed, which illustrate the potential benefit of using TEM to monitor and guide and individualize therapy during a massive transfusion.


CONCLUSIONS
It is feasible to use TEM in a deployed military setting. We have shown that rotational thromboelastometry significantly detects more abnormalities in the coagulation status than the standard laboratory tests (prothrombin time, and activated partial thromboplastin time).
Doran
Catherine M
CM
Academic Department of Military Surgery and Trauma, Royal Centre of Defence Medicine, Institute of Research and Development, Birmingham Research Park, Birmingham, United Kingdom. cmcdoran@yahoo.co.uk
Woolley
Tom
T
Midwinter
Mark J
MJ
D000293:Adolescent; D000328:Adult; D001777:Blood Coagulation / Q000502:physiology*; D001778:Blood Coagulation Disorders / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D001803:Blood Transfusion; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008889:Military Personnel; D010314:Partial Thromboplastin Time / Q000379:methods; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011517:Prothrombin Time / Q000379:methods; D015203:Reproducibility of Results; D013916:Thrombelastography / Q000379:methods* / Q000706:statistics & numerical data; D014193:Trauma Centers; D014481:United States; D014857:Warfare; D014947:Wounds and Injuries / Q000097:blood / Q000150:complications* / Q000175:diagnosis; D055815:Young Adult