title: Initial experiences with point-of-care rapid thrombelastography for management of life-threatening postinjury coagulopathy.
abstract: BACKGROUND
  Massive transfusion (MTP) protocol design is hindered by lack of accurate assessment of coagulation. Rapid thrombelastography (r-TEG) provides point-of-care (POC) analysis of clot formation. We designed a prospective study to test the hypothesis that integrating TEG into our MTP would facilitate goal-directed therapy and provide equivalent outcomes compared to conventional coagulation testing.
  
  
  METHODS
  Thiry-four patients who received more than 6 units of red blood cells (RBCs)/6 hours who were admitted to our Level 1 trauma center after r-TEG implementation (TEG) were compared to 34 patients admitted prior to TEG implementation (Pre-TEG). Data are presented as mean±SEM.
  
  
  RESULTS
  Emergency department pre-TEG versus TEG shock, and coagulation indices, were not different: systolic blood pressure (94 mmHg vs. 101 mmHg), temperature (35.3°C vs. 35.9°C), pH (7.16 vs. 7.11), base deficit (-13.0 vs. -14.7), lactate (6.5 vs. 8.1), international normalized ratio (INR; 1.59 vs. 1.83), and partial thromboplastin time (48.3 vs. 57.9). Although not significant, patients with Injury Severity Score range 26 to 35 were more frequent in the pre-TEG group. Fresh-frozen plasma (FFP):RBCs, platelets:RBCs, and cryoprecipitate (cryo):RBC ratios were not significantly different at 6 or 12 hours. INR at 6 hours did not discriminate between survivors and nonsurvivors (p=0.10), whereas r-TEG "G" value was significantly associated with survival (p=0.03), as was the maximum rate of thrombin generation (MRTG; mm/min) and total thrombin generation (TG; area under the curve) (p=0.03 for both). Patients with MRTG of more than 9.2 received significantly less components of RBCs, FFP, and cryo (p=0.048, p=0.03, and p=0.04, respectively).
  
  
  CONCLUSIONS
  Goal-directed resuscitation via r-TEG appears useful for management of trauma-induced coagulopathy. Further experience with POC monitoring could result in more efficient management leading to a reduction of transfusion requirements.
authors.affiliation: Department of Surgery and Anesthesia, Denver Health Medical Center, Denver, Colorado, USA. jeffrykashuk@gmail.com
authors.forename: Jeffry L
authors.initials: JL
authors.lastname: Kashuk
authors.forename: Ernest E
authors.initials: EE
authors.lastname: Moore
authors.forename: Max
authors.initials: M
authors.lastname: Wohlauer
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Johnson
authors.forename: Michael
authors.initials: M
authors.lastname: Pezold
authors.forename: Jerry
authors.initials: J
authors.lastname: Lawrence
authors.forename: Walter L
authors.initials: WL
authors.lastname: Biffl
authors.forename: C Clay Cothren
authors.initials: CC
authors.lastname: Burlew
authors.forename: Carlton
authors.initials: C
authors.lastname: Barnett
authors.forename: Michael
authors.initials: M
authors.lastname: Sawyer
authors.forename: Angela
authors.initials: A
authors.lastname: Sauaia
mesh_terms: D000328:Adult; D001778:Blood Coagulation Disorders / Q000628:therapy*; D016913:Blood Component Transfusion; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D013916:Thrombelastography; D014193:Trauma Centers / Q000706:statistics & numerical data; D055815:Young Adult