Thromboelastometry guided therapy of severe bleeding

H. Lier; M. Vorweg; A. Hanke; K. Görlinger

doi:10.5482/HAMO-12-05-0011

Hämostaseologie, Table of Contents

Hamostaseologie 2013; 33(01): 51-61
DOI: 10.5482/HAMO-12-05-0011

Review

Schattauer GmbH

Thromboelastometry guided therapy of severe bleeding

Essener Runde algorithmThromboelastometrie-gesteuerte Therapie massiver BlutungenAlgorithmus der Essener Runde

H. Lier

¹Department of Anaesthesiology and Intensive Care Medicine, University Hospital Cologne, Germany

,

M. Vorweg

²Administrative Department OP-Management, Cologne City Hospitals, University of Witten / Herdecke, Cologne, Germany

,

A. Hanke

³Department of Anaesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany

,

K. Görlinger

⁴Tem International GmbH, Munich, Germany

› Author Affiliations

Abstract

Summary

Both, severe haemorrhage and blood transfusion are associated with increased morbidity and mortality. Therefore, it is of particular importance to stop perioperative bleeding as fast and as possible to avoid unnecessary transfusion. Viscoelastic test (ROTEM® or TEG®) allow for early prediction of massive transfusion and goal-directed therapy with specific haemostatic drugs, coagulation factor concentrates, and blood products. Growing consensus points out, that plasma-based coagulation screening tests like aPTT and PT are inappropriate for monitoring coagulo pathy or guide transfusion therapy. Increasing evidence of more than 5000 surgical or trauma patients points towards the beneficial effects of a thrombelastography or –metry based approach in diagnosis and goal-directed therapy of perioperative massive haemorrhage. The Essener Runde task force is a group of clinicians of various specialties (anaesthesiology, intensive care, haemostaseology, haematology, internal medicine, transfusion medicine, surgery) interested in perioperative coagulation management. The ROTEM diagnostic algorithm of the Essener Runde task force was created to standardise and simplify the interpretation of ROTEM® results in perioperative settings and to present their possible implications for therapeutic interventions in severe bleeding. To exemplify, this text mainly focuses on coagulation management in trauma.

Zusammenfassung

Sowohl massive Blutungen wie auch Blut -(produkt)transfusionen sind mit einer Zunahme der Morbidität und Mortalität verbunden. Es ist daher von entscheidender Bedeutung, perioperative Blutungen schnellstmöglich zu stoppen und somit unnötige Transfusionen zu vermeiden. Viskoelastische Tests (ROTEM® oder TEG®) ermöglichen eine frühzeitige Er-kennung einer drohenden Massivtransfusion sowie die zielgerichtete Therapie mit spezifischen, die Hämostase fördernden Medika-menten, Gerinnungsfaktorkonzentraten und Blutprodukten. In zunehmender Einigkeit werden plasma-basierte Gerinnungstest wie aPTT und PT als ungeeignet zur Diagnostik einer Koagulopathie oder Steuerung der Transfusionstherapie angesehen. An mittler-weile über 5000 operativen und traumatischen Patienten konnte der sinnvolle Einsatz thrombelastometrischer und -grafischer Ver-fahren zur Diagnose und zielgerichteten Therapie massiver Blutungen gezeigt wer-den. Die “Essener Runde” ist eine Gruppe aus klinisch tätigen Medizinern verschiede-ner Disziplinen, die sich mit perioperativer Gerinnung beschäftigt. Der diagnostische ROTEM-Algorithmus der Essener Runde wurde entwickelt um eine Standardisierung und Vereinfachung der Interpretation von ROTEM® Ergebnissen im perioperativen Umfeld zu ermöglichen und die sich daraus erg-ebenen therapeutischen Optionen zubeschreiben. Der Text zeigt dies am Beispiel des Gerinnungsmanagements bei Poly traumata.

Keywords

Coagulopathy - haemorrhage - thromboelastometry - ROTEM

Schlüsselwörter

Koagulopathie - Massivblutung - Thromboelastometrie - ROTEM

Full Text

References

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