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Related Experiment Video

Updated: Feb 8, 2026

Arthroscopic Management of Massive Irreparable Rotator Cuff Tears: Whole Rotator Cable Reconstruction Using Proximal Biceps Tendon Autograft
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Rotational thromboelastometry thresholds for patients at risk for massive transfusion.

Gregory R Stettler1, Ernest E Moore2, Geoffrey R Nunns1

  • 1Department of Surgery, University of Colorado, Aurora, Colorado.

The Journal of Surgical Research
|June 17, 2018
PubMed
Summary
This summary is machine-generated.

This study establishes rotational thromboelastometry (ROTEM) thresholds for massive transfusion (MT) protocols. These ROTEM blood product transfusion guidelines aim to improve outcomes for severely injured patients requiring MT.

Keywords:
CoagulopathyMassive transfusionROTEMResuscitationTEG

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Area of Science:

  • Trauma resuscitation
  • Hemostasis and thrombosis
  • Viscoelastic hemostatic assays

Background:

  • Goal-directed hemostatic resuscitation using thrombelastography improves survival compared to conventional coagulation assays.
  • Transfusion thresholds for massive transfusion (MT) are established for thrombelastography but not for rotational thromboelastometry (ROTEM).
  • This study aimed to define ROTEM-based blood product transfusion thresholds for patients at risk for MT.

Purpose of the Study:

  • To develop and validate ROTEM-derived blood product transfusion thresholds for trauma patients at risk for massive transfusion.
  • To establish specific ROTEM parameter cutoffs to guide resuscitation decisions in severely injured patients.

Main Methods:

  • Retrospective analysis of 222 trauma activation patients from 2010-2016.
  • Receiver operating characteristic (ROC) curve analysis to determine the predictive performance of ROTEM parameters for MT.
  • Youden Index was used to identify optimal ROTEM thresholds for guiding blood product transfusion.

Main Results:

  • Patients requiring MT (17%) had significantly longer EXTEM clotting times (CT), shallower angles, lower clot amplitude (CA10), and lower clot lysis index 60 min (CLI60) compared to non-MT patients.
  • Optimal ROTEM thresholds identified: EXTEM CT >78.5 s, EXTEM angle <64.5°, EXTEM CA10 <40.5 mm, and CLI60 <74%.
  • These thresholds demonstrated predictive value for identifying patients who would require MT.

Conclusions:

  • Rotational thromboelastometry (ROTEM) can guide blood product transfusion in massively transfused trauma patients.
  • Proposed ROTEM thresholds include plasma for EXTEM CT >78.5 s, fibrinogen for angle <64.5°, platelets for CA10 <40.5 mm, and antifibrinolytics for CLI60 <74%.
  • Implementation of these ROTEM thresholds may optimize resuscitation strategies and improve patient outcomes.