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Implementation of a maternity hospital rotational thromboelastometry (ROTEM®) guided transfusion strategy: a quality
H Tawfik1, L Pentony2, R M O'Donovan2
1Department of Anaesthesia Rotunda Hospital Dublin Ireland.
Anaesthesia Reports
|September 22, 2025
Summary
Implementing a rotational thromboelastometry (ROTEM) guided transfusion strategy for postpartum hemorrhage significantly reduced coagulation product use and costs. This evidence-based approach improved compliance without negatively impacting patient outcomes.
Area of Science:
- Obstetrics and Gynecology
- Hematology
- Health Services Research
Background:
- Postpartum hemorrhage (PPH) management traditionally relies on standard laboratory tests, which may lead to delayed or suboptimal transfusion decisions.
- Viscoelastic hemostatic testing, such as rotational thromboelastometry (ROTEM), offers real-time assessment of coagulation status.
- Implementing new transfusion strategies requires robust decision support and staff education for effective adoption.
Purpose of the Study:
- To evaluate the impact of a ROTEM-guided transfusion strategy on coagulation product utilization and costs in severe PPH.
- To assess adherence to evidence-based transfusion triggers following the implementation of the ROTEM strategy.
- To determine if the ROTEM-guided strategy affected the progression to severe hemorrhage.
Main Methods:
- A retrospective analysis compared 1 year of data post-ROTEM implementation with 4 years of data pre-implementation for PPH (≥1500 ml).
- Data included 944 women experiencing severe PPH, analyzing the use of fibrinogen concentrate, Octaplas, and platelets.
- An electronic decision tool integrated into a smartphone application supported the ROTEM strategy, alongside departmental training.
Main Results:
- Annual use of fibrinogen concentrate, Octaplas, and platelets decreased by 46%, 72%, and 79%, respectively.
- Cost savings of €51,738 were achieved.
- Compliance with fibrinogen transfusion triggers improved from 23% to 84%, eliminating empirical product use.
- No significant difference in progression to severe hemorrhage (≥2000 ml) was observed between groups.
Conclusions:
- A ROTEM-guided transfusion strategy, supported by a decision tool and training, enhances adherence to evidence-based practice in obstetric hemorrhage.
- This approach significantly reduces unnecessary coagulation product use and associated costs.
- The implementation of ROTEM-guided transfusion does not adversely affect clinical outcomes in severe PPH.
