Literatür Detay Bilgisi
FIBTEM provides early prediction of massive transfusion in trauma.

Yazarlar : Schochl H, Cotton B, Inaba K, Nienaber U, Fischer H, Voelckel W, Solomon C.

Yayın : Crit Care.

Yayın Yılı : 2011

Pubmed Linki : http://www.ncbi.nlm.nih.gov/pubmed/22078266

Konu : Transfüzyon

Literatür İçeriği :  

Abstract

ABSTRACT:

INTRODUCTION:

Prediction of massive transfusion (MT) among trauma patients is difficult in the early phase of trauma management. Whole-blood thromboelastometry (ROTEM(R)) tests provide immediate information about the coagulation status of acute bleeding trauma patients. We investigated their value for early prediction of MT.

METHODS:

This retrospective study included patients admitted to the AUVA Trauma Centre, Salzburg, with an injury severity score [greater than or equal to]16, from whom blood samples were taken immediately upon admission to the emergency room (ER). ROTEM analyses (extrinsically-activated test with tissue factor [EXTEM], intrinsically-activated test using ellagic acid [INTEM] and fibrin-based extrinsically activated test with tissue factor and the platelet inhibitor cytochalasin D [FIBTEM] tests) were performed. We divided patients into two groups: massive transfusion (MT; those who received [greater than or equal to]10 units red blood cell concentrate within 24 hours of admission) and non-MT (those who received 0-9 units).

RESULTS:

Of 323 patients included in this study (78.9% male; median age 44 years), 78 were included in the MT group and 245 in the non-MT group. The median injury severity score upon admission to the ER was significantly higher in the MT group than in the non-MT group (42 vs 27, p<0.0001). EXTEM and INTEM clotting time and clot formation time were significantly prolonged and maximum clot firmness (MCF) was significantly lower in the MT group versus the non-MT group (p<0.0001 for all comparisons). Of patients admitted with FIBTEM MCF 0-3 mm, 85% received MT. The best predictive values for MT were provided by hemoglobin and Quick value (area under receiver operating curve: 0.87 for both parameters). Similarly high predictive values were observed for FIBTEM MCF (0.84) and FIBTEM A10 (clot amplitude at 10 minutes; 0.83).

CONCLUSIONS:

FIBTEM A10 and FIBTEM MCF provided similar predictive values for massive transfusion in trauma patients to the most predictive laboratory parameters. Prospective studies are needed to confirm these findings.


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