It has been argued that viscoelastic point-of-care testing provides faster and more accurate results than conventional diagnostic assays to guide the management of trauma coagulopathy. However, it remains unclear which tests and results should be used in trauma resuscitation protocols.
The authors performed a systematic review of 13 observational trials including 2835 trauma patients using the ROTEM® technology for diagnosis and blood product administration. Outcomes such as diagnosis of coagulopathy (from 10 studies) as well as massive transfusion and mortality were predicted and affected by the ROTEM® tests Extem and Fibtem (parameters CA clot amplitude after 5 min, 10 min and MCF maximal clot firmness). Diagnosis of fibrinolysis was associated with higher mortality.
The authors conclude that the use of ROTEM® parameters clot amplitude after 5 and 10 min and maximal clot firmness in an extrinsic and fibrinogen test can effectively guide transfusion algorithms and coagulation management in trauma. Although the second and third authors disclose relevant conflicts of interest and data quality is only moderate, from mostly uncontrolled but prospective studies with moderate risk of bias, the results are consistent across all selected studies. The information obtained in this systematic review will be helpful to determine the basic requirements for controlled trials and the randomised comparison to standard coagulation tests.
– Thomas Frietsch