Multicenter survey on viscoelastic assays access and use in trauma in Swiss emergency departments

Trauma is a global cause of morbidity and mortality, with early deaths frequently resulting from hemorrhage and traumatic brain injury. Prompt assessment and targeted management of bleeding and trauma-induced coagulopathy are essential in this context. Viscoelastic tests (VETs), such as TEG and ROTEM, offer advantages over conventional coagulation. Therefore, we wanted to evaluate their availability and use in Swiss emergency departments (EDs).

A 16-item online survey assessing access, use, and training related to VET, as well as the use of massive hemorrhage protocols, was distributed to 52 EDs recognized by the Swiss Society of Emergency and Rescue Medicine. Twelve were level-1 trauma centers, five of which were university hospitals.

The response rate was 86.5% (45/52). Access to VET was reported by 44.4% of centers, while routine use in major trauma was noted in 26.7%. Most users were trauma centers. Devices were predominantly located outside the ED (e.g., laboratories or operating rooms). Over half of the centers with access to VET reported no formal training. Additionally, 51.1% of respondents indicated the absence of a dedicated massive hemorrhage protocol. Among those with protocols, most used conventional coagulation tests, and fewer included VET.

The use of VET in Swiss EDs is limited, mainly to trauma centers, with restricted point-of-care access and heterogeneous training. Massive hemorrhage protocols are inconsistently implemented and often lack integration of VET. Key areas for improvement include expanding access beyond specialized centers, standardizing protocols and interpretation algorithms, optimizing device placement, and introducing structured training programs.