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Prehospital Thrombolysis: A Manual from Berlin
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Thromboelastometry guided therapy of severe bleeding. Essener Runde algorithm.

H Lier1, M Vorweg, A Hanke

  • 1Department of Anaesthesiology and Intensive Care, Medicine University Hospital of Cologne, Kerpener Straße 62, 50937 Cologne, Germany. Heiko.Lier@uk-koeln.de

Hamostaseologie
|December 22, 2012
PubMed
Summary
This summary is machine-generated.

Viscoelastic tests like rotational thromboelastometry (ROTEM) enable early prediction and goal-directed therapy for severe bleeding. This approach is superior to traditional plasma-based tests for managing perioperative hemorrhage, especially in trauma.

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Area of Science:

  • Coagulation Management
  • Transfusion Medicine
  • Trauma Care

Background:

  • Severe hemorrhage and blood transfusions increase patient morbidity and mortality.
  • Rapid control of perioperative bleeding is crucial to minimize unnecessary transfusions.
  • Plasma-based coagulation tests (aPTT, PT) are increasingly recognized as inadequate for guiding therapy in coagulopathy.

Purpose of the Study:

  • To present the Essener Runde task force's ROTEM diagnostic algorithm for standardizing interpretation.
  • To simplify the application of viscoelastic testing in perioperative settings.
  • To outline therapeutic interventions for severe bleeding based on ROTEM results, focusing on trauma.

Main Methods:

  • Utilizing viscoelastic hemostatic assays (VHAs) such as ROTEM® or TEG®.
  • Implementing a goal-directed therapy approach based on VHA results.
  • Applying the Essener Runde ROTEM diagnostic algorithm for interpretation and treatment guidance.

Main Results:

  • Viscoelastic testing allows for early prediction of massive transfusion needs.
  • Evidence from over 5000 patients supports the benefits of VHA-based diagnosis and therapy for perioperative hemorrhage.
  • ROTEM-guided therapy facilitates targeted use of hemostatic drugs and blood products.

Conclusions:

  • Viscoelastic testing offers a superior method for diagnosing and managing perioperative coagulopathy and massive hemorrhage compared to traditional tests.
  • The Essener Runde algorithm provides a standardized framework for interpreting ROTEM results and guiding therapeutic decisions.
  • VHA-based management, particularly in trauma, improves outcomes by enabling timely and specific interventions.