Initial experiences with point-of-care rapid thrombelastography for management of life-threatening postinjury coagulopathy
Initial experiences with point-of-care rapid thrombelastography for management of life-threatening postinjury coagulopathy
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DOI：
10.1111/j.1537-2995.2011.03264.x
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发表时间：
2012-01-01
期刊：
影响因子：
2.9
通讯作者：
Sauaia, Angela
中科院分区：
文献类型：
--
作者：
Kashuk, Jeffry L.;Moore, Ernest E.;Sauaia, Angela
背景：大量输血（MTP）方案设计因缺乏准确的凝血评估而受阻。快速血栓弹性描记术（r-TEG）提供了对凝块形成的即时（POC）分析。我们设计了一项前瞻性研究来检验这一假设，即将TEG整合到我们的MTP中将有助于目标导向治疗，并提供与传统凝血试验相同的结果。34名接受超过6单位红细胞（RBC）/6小时的患者在r-TEG实施（TEG）后入住我们的1级创伤中心与TEG实施前（Pre-TEG）收治的34例患者进行比较。数据表示为平均值+/- SEM。结果：急诊科预TEG与TEG休克和凝血指标无差异：收缩压（94 mmHg vs. 101 mmHg），体温（35.3摄氏度与35.9摄氏度），pH值（7.16 vs. 7.11），基数赤字（-13.0 vs. -14.7）、乳酸（6.5 vs. 8.1）、国际标准化比值（INR; 1.59 vs. 1.83）和部分凝血活酶时间（48.3 vs. 57.9）。尽管不显著，但损伤严重度评分范围为26 - 35的患者在前TEG组中更常见。新鲜冷冻血浆（FFP）：RBC、血小板：RBC和冷沉淀（cryo）：RBC比值在6或12小时时无显著差异。6小时的INR不能区分存活者和非存活者（p = 0.10），而r-TEG“G”值与存活率显著相关（p = 0.03），凝血酶生成的最大速率（MRTG; mm/min）和总凝血酶生成（TG;曲线下面积）也是如此（两者p = 0.03）。MRTG大于9.2的患者接受的RBC、FFP和冷冻成分显著较少（分别为p = 0.048、p = 0.03和p = 0.04）。结论：通过r-TEG进行目标导向复苏似乎对创伤诱导的凝血功能障碍的管理有用。POC监测的进一步经验可能导致更有效的管理，从而减少输血需求。
BACKGROUND: Massive transfusion (MTP) protocol design is hindered by lack of accurate assessment of coagulation. Rapid thrombelastography (r-TEG) provides point-of-care (POC) analysis of clot formation. We designed a prospective study to test the hypothesis that integrating TEG into our MTP would facilitate goal-directed therapy and provide equivalent outcomes compared to conventional coagulation testing.STUDY DESIGN AND METHODS: Thiry-four patients who received more than 6 units of red blood cells (RBCs)/6 hours who were admitted to our Level 1 trauma center after r-TEG implementation (TEG) were compared to 34 patients admitted prior to TEG implementation (Pre-TEG). Data are presented as mean +/- SEM.RESULTS: Emergency department pre-TEG versus TEG shock, and coagulation indices, were not different: systolic blood pressure (94 mmHg vs. 101 mmHg), temperature (35.3 degrees C vs. 35.9 degrees C), pH (7.16 vs. 7.11), base deficit (-13.0 vs. -14.7), lactate (6.5 vs. 8.1), international normalized ratio (INR; 1.59 vs. 1.83), and partial thromboplastin time (48.3 vs. 57.9). Although not significant, patients with Injury Severity Score range 26 to 35 were more frequent in the pre-TEG group. Fresh-frozen plasma (FFP) : RBCs, platelets : RBCs, and cryoprecipitate (cryo) : RBC ratios were not significantly different at 6 or 12 hours. INR at 6 hours did not discriminate between survivors and nonsurvivors (p = 0.10), whereas r-TEG "G" value was significantly associated with survival (p = 0.03), as was the maximum rate of thrombin generation (MRTG; mm/min) and total thrombin generation (TG; area under the curve) (p = 0.03 for both). Patients with MRTG of more than 9.2 received significantly less components of RBCs, FFP, and cryo (p = 0.048, p = 0.03, and p = 0.04, respectively).CONCLUSION: Goal-directed resuscitation via r-TEG appears useful for management of trauma-induced coagulopathy. Further experience with POC monitoring could result in more efficient management leading to a reduction of transfusion requirements.