Rapid thrombelastography thresholds for goal-directed resuscitation of patients at risk for massive transfusion.
Rapid thrombelastography thresholds for goal-directed resuscitation of patients at risk for massive transfusion.
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DOI：
10.1097/ta.0000000000001270
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发表时间：
2017-01
期刊：
影响因子：
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通讯作者：
Sauaia A
中科院分区：
文献类型：
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作者：
Einersen PM;Moore EE;Chapman MP;Moore HB;Gonzalez E;Silliman CC;Banerjee A;Sauaia A
失控出血是创伤后死亡的主要原因，占死亡人数的40%。大量输血方案(MTP)在这些患者的复苏中提供了被证实的好处。最近，血栓弹性成像(TEG)引导的复苏策略比传统的凝血试验(CCA)引导的策略的优越性已经被证实。我们寻求确定r-TEG驱动复苏的最佳阈值。我们回顾了从2010年到2015年在我们一级创伤中心就诊的190名患者的R-TEG数据。纳入标准为18岁的≥患者创伤活动性最高，推测为急性失血所致低血压。排除标准包括：孤立的头部枪伤、怀孕和慢性肝病。受试者工作特性(ROC)分析用于检验r-TEG对大输血需求量的预测性能：1)前6小时内需要10单位红细胞总数或死亡；2)前6小时内任一小时内4单位红细胞。然后进行切点分析，以确定基于TEG的复苏的最佳阈值。对r-TEG的ROC分析显示，除活化凝血时间(ACT)和前6小时内任何一小时的4U红细胞30分钟裂解(LY30)外，所有输血量相对于所考虑的输血阈值而言，曲线下面积(AUC)均大于70%。对所得ROC曲线进行最佳切割点分析，并针对每个值确定最敏感的切割点，分别为≥128秒、角度(α)≤65)、最大幅度(MA)≤55 mm和LY30≥5%。通过对前瞻性TEG数据的ROC分析，我们确定了指导止血复苏的最佳阈值。这些阈值应该在一项前瞻性多中心试验中得到验证。预测，III级
Uncontrolled hemorrhage is a leading cause of mortality following trauma accounting for up to 40% of deaths. Massive transfusion protocols (MTPs) offer a proven benefit in resuscitation of these patients. Recently, the superiority of thrombelastography (TEG)-guided resuscitation over strategies guided by conventional clotting assays (CCA) has been established. We seek to determine optimal thresholds for r-TEG driven resuscitation. R-TEG data were reviewed for 190 patients presenting to our Level 1 Trauma Center from 2010 to 2015. Criteria for inclusion were highest level trauma activation in patients ≥ 18 years of age with hypotension presumed due to acute blood loss. Exclusion criteria included: isolated gun-shot wound to the head, pregnancy and chronic liver disease. Receiver operating characteristic (ROC) analysis was performed to test the predictive performance of r-TEG for massive transfusion requirement defined by need for 1) >10 units of RBCs total or death in the first six hours or 2) >4 units of RBCs in any hour within the first 6 hours. Cut-point analysis was then performed to determine optimal thresholds for TEG-based resuscitation. ROC analysis of r-TEG yielded areas under the curve (AUC) greater than 70% for all outputs with respect to both transfusion thresholds considered, with exception of activated clotting time (ACT) and lysis at 30 minutes (LY30) for > 4U RBC in any hour in the first 6 hours. Optimal cut-point analysis of the resultant ROC curves was performed and for each value, the most sensitive cut-point was identified, respectively ACT ≥ 128 sec, angle (α) ≤ 65, maximum amplitude (MA) ≤ 55 mm and LY30 ≥ 5%. Through ROC analysis of prospective TEG data, we have identified optimal thresholds to guide hemostatic resuscitation. These thresholds should be validated in a prospective multicenter trial. Prognostic, level III