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Rotational thromboelastometry-guided trauma resuscitation.

Damian D Keene1, Giles R Nordmann, Tom Woolley

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Summary
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Rotational thromboelastometry (ROTEM) aids rapid coagulation assessment in trauma, guiding blood product use. While evidence in trauma is limited, UK Defence Medical Service experience shows ROTEM is a fast, reliable tool for identifying transfusion needs.

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Area of Science:

  • Trauma resuscitation
  • Coagulation monitoring
  • Point-of-care diagnostics

Background:

  • Major trauma hemorrhage is a leading cause of death globally.
  • The UK Defence Medical Service (UK-DMS) has extensive experience managing severely injured patients.
  • Rotational thromboelastometry (ROTEM) has been integrated into damage control resuscitation protocols by the UK-DMS.

Purpose of the Study:

  • To review the rationale for using ROTEM in trauma resuscitation.
  • To describe the evolution of ROTEM use within the UK-DMS.
  • To assess the current evidence base for ROTEM in trauma care.

Main Methods:

  • Review of UK-DMS experience with ROTEM in Afghanistan.
  • Analysis of recent studies and meta-analyses on ROTEM in trauma.
  • Consideration of European guidelines on ROTEM use.

Main Results:

  • Evidence for ROTEM in trauma is limited compared to cardiac/liver surgery.
  • Studies show reduced transfusion rates and blood loss, but no mortality benefit.
  • UK-DMS experience highlights ROTEM as a fast, reliable method for assessing transfusion needs.

Conclusions:

  • ROTEM enables rapid coagulation assessment in trauma casualties.
  • It facilitates targeted blood product administration.
  • Further evaluation of ROTEM's role in trauma is warranted.