The role of evidence-based algorithms for rotational thromboelastometry-guided bleeding management

Area of Science:

• Point-of-care diagnostics
• Hemostasis and thrombosis
• Patient blood management

Background:

• Rotational thromboelastometry (ROTEM) is a viscoelastic point-of-care method for assessing whole blood hemostasis.
• Patient blood management (PBM) is crucial for improving patient safety, particularly in managing bleeding.
• Integrating ROTEM into PBM requires evidence-based, adaptable algorithms.

Purpose of the Study:

• To highlight the role of ROTEM-guided algorithms in perioperative bleeding management.
• To emphasize the 'theranostic' approach of personalized medicine in hemostasis.
• To review the evidence supporting ROTEM-guided PBM.

Main Methods:

• Utilizing ROTEM for real-time viscoelastic assessment of blood.
• Developing and implementing setting-specific, evidence-based algorithms for ROTEM-guided interventions.
• Analyzing data from randomized-controlled trials, meta-analyses, and health technology assessments.

Main Results:

• ROTEM-guided PBM effectively reduces bleeding, transfusion needs, complications, and healthcare costs.
• Evidence supports improved patient safety and outcomes, including reduced perioperative morbidity and mortality.
• ROTEM implementation facilitates a personalized or precision medicine approach ('theranostic').

Conclusions:

• ROTEM-guided algorithms are effective in optimizing perioperative bleeding management and patient outcomes.
• Successful implementation necessitates comprehensive training, education, logistics, and interdisciplinary collaboration.
• ROTEM integration into PBM represents a significant advancement in patient safety and care.