Rotational thromboelastometry-guided trauma resuscitation.
OBJECTIVE
Haemorrhage from major trauma is a significant cause of death worldwide. The UK Defence Medical Service (UK-DMS) has had significant experience in managing severely injured and shocked trauma casualties over the last decade. This has led to the integration of rotational thromboelastometry (ROTEM) into damage control resuscitation delivered at Camp Bastion Field Hospital in Afghanistan. This review aims to describe the rationale for its use and how its use has evolved by UK-DMS.


RESULTS
Although there is reasonable evidence showing its benefit in cardiac and liver surgery, evidence for its use in trauma is limited. More recent studies and meta-analyses have demonstrated a reduced rate of transfusion and blood loss, but no benefit on mortality. Despite this, there is a growing body of opinion supporting ROTEM use in trauma with European guidelines supporting its use where available. Recent UK-DMS experience has shown that it is a fast, reliable and robust means of identifying transfusion requirements.


CONCLUSIONS
ROTEM provides a means to rapidly assess coagulation in trauma casualties, allowing targeted use of blood products. It provides information on clot initiation strength and breakdown. However, its use in trauma has still to be fully evaluated.
Department of Military Anaesthesia and Critical Care, Royal Centre for Defence Medicine, Birmingham, UK.
Damian D
DD
Keene
Giles R
GR
Nordmann
Tom
T
Woolley
D055826:Afghan Campaign 2001-; D001803:Blood Transfusion / Q000379:methods; D005260:Female; D006470:Hemorrhage / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D008889:Military Personnel; D019095:Point-of-Care Systems / Q000639:trends; D012151:Resuscitation / Q000379:methods*; D013916:Thrombelastography / Q000379:methods / Q000639:trends; D006113:United Kingdom; D014947:Wounds and Injuries / Q000150:complications / Q000401:mortality / Q000628:therapy*