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Semin Thromb Hemost 2022; 48(07): 796-807
DOI: 10.1055/s-0042-1756305
Review Article

Advances in the Management of Coagulopathy in Trauma: The Role of Viscoelastic Hemostatic Assays across All Phases of Trauma Care

Jonathan P. Meizoso   *
1   DeWitt Daughtry Family Department of Surgery, Ryder Trauma Center, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, Florida
,
Christopher D. Barrett   *
2   Center for Precision Cancer Medicine, Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts
3   Department of Surgery, Boston University Medical Center, Boston University School of Medicine, Boston, Massachusetts
,
Ernest E. Moore
4   Department of Surgery, University of Colorado Denver, Aurora, Colorado
5   Department of Surgery, Ernest E. Moore Shock Trauma Center at Denver Health, Denver, Colorado
,
Hunter B. Moore
4   Department of Surgery, University of Colorado Denver, Aurora, Colorado
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Abstract

Uncontrolled bleeding is the leading cause of preventable death following injury. Trauma-induced coagulopathy can manifest as diverse phenotypes ranging from hypocoagulability to hypercoagulability, which can change quickly during the acute phase of trauma care. The major advances in understanding coagulation over the past 25 years have resulted from the cell-based concept, emphasizing the key role of platelets and their interaction with the damaged endothelium. Consequently, conventional plasma-based coagulation testing is not accurate in predicting bleeding and does not provide an assessment of which blood products are indicated. Viscoelastic hemostatic assays (VHA), conducted in whole blood, have emerged as a superior method to guide goal-directed transfusion. The major change in resuscitation has been the shift from unbridled crystalloid loading to judicious balanced blood product administration. Furthermore, the recognition of the rapid changes from hypocoagulability to hypercoagulability has underscored the importance of ongoing surveillance beyond emergent surgery. While the benefits of VHA testing are maximized when used as early as possible, current technology limits use in the pre-hospital setting and the time to results compromises its utility in the emergency department. Thus, most of the reported experience with VHA in trauma is in the operating room and intensive care unit, where there is compelling data to support its value. This overview will address the current and potential role of VHA in the seriously injured patient, throughout the continuum of trauma management.

Keywords

viscoelastic assay - thrombelastography - rotational thromboelastometry - trauma - hemorrhage - coagulopathy

* Co–first authors.




Publication History

Article published online:
16 September 2022

© 2022. Thieme. All rights reserved.

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