The "Death Diamond": Rapid thrombelastography identifies lethal hyperfibrinolysis

Area of Science:

• Trauma resuscitation
• Hemostasis and thrombosis
• Critical care medicine

Background:

• Postinjury hyperfibrinolysis (HF), identified by LY30 ≥ 3% on rTEG, is linked to high mortality and blood product use.
• Some HF cases are reversible with resuscitation, while others indicate inevitable demise.
• A distinct rTEG pattern for unsurvivable HF was sought.

Purpose of the Study:

• To define a recognizable rTEG tracing pattern associated with unsurvivable postinjury hyperfibrinolysis.
• To assess the predictive value of this pattern for mortality in trauma patients.

Main Methods:

• Retrospective analysis of trauma registry data for patients with admission rTEG.
• Matched cohort study comparing survivors and non-survivors.
• Identification and validation of a specific rTEG pattern in non-survivors.

Main Results:

• A "diamond-shaped" rTEG pattern with rapid clot lysis (time to max amplitude ≤ 14 min, complete lysis before LY30) was identified in non-survivors with HF.
• This pattern was absent in survivors with HF.
• Applied to a larger cohort, the pattern demonstrated 100% positive predictive value for mortality.

Conclusions:

• The
• death diamond
• rTEG pattern identifies trauma patients at high risk of mortality.
• This objective criterion may help guide decisions to discontinue hemostatic resuscitation efforts.