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Semin Thromb Hemost 2020; 46(02): 134-146
DOI: 10.1055/s-0040-1702171
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Diagnosis and Treatment of Trauma-Induced Coagulopathy by Viscoelastography

Jan Hartmann
1   Haemonetics Corporation, Boston, Massachusetts
,
Mark Walsh
2   Saint Joseph Regional Medical Center, Mishawaka, Indiana
3   Memorial Hospital Trauma Center, South Bend, Indiana
4   W. M. Keck Center for Transgene Research, University of Notre Dame, Notre Dame, Indiana
,
Anne Grisoli
5   Indiana University School of Medicine—South Bend Campus, Notre Dame, Indiana
,
Anthony V. Thomas
2   Saint Joseph Regional Medical Center, Mishawaka, Indiana
3   Memorial Hospital Trauma Center, South Bend, Indiana
,
Faisal Shariff
5   Indiana University School of Medicine—South Bend Campus, Notre Dame, Indiana
,
Ross McCauley
5   Indiana University School of Medicine—South Bend Campus, Notre Dame, Indiana
,
Stefani Vande Lune
5   Indiana University School of Medicine—South Bend Campus, Notre Dame, Indiana
,
Nuha Zackariya
2   Saint Joseph Regional Medical Center, Mishawaka, Indiana
3   Memorial Hospital Trauma Center, South Bend, Indiana
,
Shivani Patel
2   Saint Joseph Regional Medical Center, Mishawaka, Indiana
3   Memorial Hospital Trauma Center, South Bend, Indiana
,
Michael S. Farrell
6   Department of Trauma, Surgery, and Critical Care Medicine, Christiana Care Health Services, Wilmington, Delaware
,
Sherry Sixta
6   Department of Trauma, Surgery, and Critical Care Medicine, Christiana Care Health Services, Wilmington, Delaware
,
Robert March
2   Saint Joseph Regional Medical Center, Mishawaka, Indiana
,
Edward Evans
2   Saint Joseph Regional Medical Center, Mishawaka, Indiana
,
Rebecca Tracy
7   Department of Emergency Medicine, Southern Illinois University School of Medicine, Springfield, Illinois
,
Elena Campello
8   Thrombotic and Hemorrhagic Diseases Unit, Department of Medicine, Padua University Hospital, Padua, Italy
,
Ecaterina Scărlătescu
9   Department of Anaesthesia and Intensive Care, Fundeni Clinical Institute, Bucharest, Romania
,
Vanessa Agostini
10   Department of Clinical Pathology, Transfusion Medicine Cesena/Forlì and Blood Establishment, Azienda USL della Romagna, Romagna, Italy
,
João Dias
11   Haemonetics S. A., Signy, Switzerland
,
Sarah Greve
1   Haemonetics Corporation, Boston, Massachusetts
,
Scott Thomas
3   Memorial Hospital Trauma Center, South Bend, Indiana
4   W. M. Keck Center for Transgene Research, University of Notre Dame, Notre Dame, Indiana
› Author Affiliations
Further Information

Publication History

Publication Date:
11 March 2020 (online)

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Abstract

This article explores the application of viscoelastic tests (VETs) in trauma-induced coagulopathy and trauma resuscitation. We describe the advantages of VETs over conventional coagulation tests in the trauma setting and refer to previous disciplines in which VET use has reduced blood product utilization, guided prohemostatic agents, and improved clinical outcomes such as the mortality of critically bleeding patients. We describe different VETs and provide guidance for blood component therapy and prohemostatic therapy based on specific VET parameters. Because the two most commonly used VET systems, rotational thromboelastometry and thromboelastography, use different activators and have different terminologies, this practical narrative review will directly compare and contrast these two VETs to help the clinician easily interpret either and use the interpretation to determine hemostatic integrity in the bleeding trauma patient. Finally, we anticipate the future of new viscoelastic technologies that can be used in this setting.

Keywords

viscoelastic testing - thromboelastography - rotational thromboelastometry - trauma-induced coagulopathy - massive transfusion - shock
 

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