Citrated kaolin thrombelastography (TEG) thresholds for goal-directed therapy in injured patients receiving massive transfusion
| Autor: | Mitchell J. Cohen, Amanda S. Conroy, Geoffrey R. Nunns, Lucy Z. Kornblith, Anirban Banerjee, Joshua J. Sumislawski, Christopher C. Silliman, Angela Sauaia, Gregory R. Stettler, Ernest E. Moore, Rachael A. Callcut |
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| Rok vydání: | 2018 |
| Předmět: |
Adult
Male Resuscitation Blood transfusion medicine.medical_treatment Hemorrhage 030204 cardiovascular system & hematology Critical Care and Intensive Care Medicine Patient Care Planning Article 03 medical and health sciences 0302 clinical medicine medicine Coagulopathy Humans Blood Transfusion Platelet Kaolin Blood Coagulation medicine.diagnostic_test business.industry 030208 emergency & critical care medicine Middle Aged medicine.disease Massive transfusion Thrombelastography ROC Curve Coagulation Area Under Curve Anesthesia Wounds and Injuries Female Surgery business Partial thromboplastin time |
| Zdroj: | Journal of Trauma and Acute Care Surgery. 85:734-740 |
| ISSN: | 2163-0763 2163-0755 |
| DOI: | 10.1097/ta.0000000000002037 |
| Popis: | Goal-directed hemostatic resuscitation based on thrombelastography (TEG) has a survival benefit compared with conventional coagulation assays such as international normalized ratio, activated partial thromboplastin time, fibrinogen level, and platelet count. While TEG-based transfusion thresholds for patients at risk for massive transfusion (MT) have been defined using rapid TEG, cutoffs have not been defined for TEG using other activators such as kaolin. The purpose of this study was to develop thresholds for blood product transfusion using citrated kaolin TEG (CK-TEG) in patients at risk for MT.CK-TEG was assessed in trauma activation patients at two Level 1 trauma centers admitted between 2010 and 2017. Receiver operating characteristic (ROC) curve analyses were performed to test the predictive performance of CK-TEG measurements in patients requiring MT, defined as10 units of red blood cells or death within the first 6 hours. The Youden Index defined optimal thresholds for CK-TEG-based resuscitation.Of the 825 trauma activations, 671 (81.3%) were men, 419 (50.8%) suffered a blunt injury, and 62 (7.5%) received a MT. Patients who had a MT were more severely injured, had signs of more pronounced shock, and more abnormal coagulation assays. CK-TEG R-time was longer (4.9 vs. 4.4 min, p = 0.0084), angle was lower (66.2 vs. 70.3 degrees, p0.0001), maximum amplitude was lower in MT (57 vs. 65.5 mm, p0.0001), and LY30 was greater (1.8% vs. 1.2%, p = 0.0012) in patients with MT compared with non-MT. To predict MT, R-time yielded an area under the ROC curve (AUROC) = 0.6002 and a cut point of4.45 min. Angle had an AUROC = 0.6931 and a cut point of67 degrees. CMA had an AUROC = 0.7425, and a cut point of60 mm. LY30 had an AUROC = 0.623 with a cut point of4.55%.We have identified CK-TEG thresholds that can guide MT in trauma. We propose plasma transfusion for R-time4.45 min, fibrinogen products for an angle67 degrees, platelet transfusion for MA60 mm, and antifibrinolytics for LY304.55%.Therapeutic study, level V. |
| Databáze: | OpenAIRE |
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