Rotational thromboelastometry significantly optimizes transfusion practices for damage control resuscitation in...

Area of Science:

• Trauma resuscitation
• Hemorrhage control
• Transfusion medicine

Background:

• Massive hemorrhage from truncal injuries causes high mortality in combat casualties before surgical intervention.
• Damage control resuscitation (DCR) empirically uses a 1:1:1:1 ratio of blood components (platelets:fresh frozen plasma:erythrocytes:cryoprecipitate).
• Rotational thromboelastometry (ROTEM) can measure hemostatic function to optimize blood product transfusion.

Purpose of the Study:

• To evaluate the impact of incorporating ROTEM measurements into DCR at a military hospital in Afghanistan.
• To determine if ROTEM use alters standard transfusion ratios for combat casualties.

Main Methods:

• Retrospective study comparing transfusion practices before and after ROTEM deployment.
• Data collected from the Department of Defense Trauma Registry.
• 134 patients in the pre-ROTEM group and 85 in the post-ROTEM group.

Main Results:

• No significant differences in mortality, massive transfusion protocol activation, or injury severity between groups.
• The post-ROTEM group showed a significant 4x increase in platelet and 2x increase in cryoprecipitate transfusion ratios.
• Total transfusions were similar despite group size differences.

Conclusions:

• ROTEM guided DCR significantly improved adherence to resuscitation practices.
• Aggressive DCR without ROTEM may lead to underestimation of platelet and cryoprecipitate needs.
• Future trials should incorporate ROTEM-guided coagulation management in trauma resuscitation.