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Wed Apr 15 11:47:53 BST 2009

There are considerable attractive features of these viscoelastic
coagulation tests for trauma patients.  They are potentially
near-patient, suitable for the ED, give a better overall picture of
the state of haemostasis and may allow directed therapy.

BUT there are very few, if any quality studies on the use of these
studies in trauma patients.  And even fewer in trauma patients who are
actually coagulopathic or are bleeding.  The RapidTEG test that Ken is
keen on has a sum total of 29 patients in the trauma literature from
what I can see.

It's also not clear what the tests are actually showing us.  There are
standard 'explanations' of what the curves mean that I can find little
experimental evidence for.  Most of the experience from ROTEM/TEG
comes from cardiac surgery and liver transplantation - who have a very
different coagulopathy from Trauma-Induced Coagulopathy.

I'm pretty sure these tests are going to be better than what we have
now (nothing!!), but I don't believe we understand TIC or the tests
themselves yet to really understand their role both in identifying TIC
and its components or to guide directed transfusion therapy.

Having said that we're just conducting a study on ROTEM in trauma, to
see whether ROTEM can identify Acute Traumatic Coagulopathy.  We've
submitted an abstract to AAST this year on our interim experience, but
it does seem that we can identify patients with ATC and who will
require transfusion on the Clot Amplitude at 5 minutes - which would
be a good starting point! - Even if only to rule out those patients
who will not need blood.

The machines themselves are still too complicated though, require too
much training, and are not really designed to cope with the emergency
environment (although they're getting better) - and don't really
address the issue of quality control in locations remote from the
labs.

By the way, the tests are properly viscoelastic tests or
thromboelastometry.  TEG is a tradename of Haemonetics corporation.
ROTEM is Rotational Thromboelastometry, which is like inverse-TEG in
its mechanics.

Karim

On 04/14/2009, kmattox at aol.com <kmattox at aol.com> wrote:
> TEG has basically replaced most other tests.  We have moved to the Rapid TEG which we get back in 5 minutes.  It is much more practical and directs Rx better than the legacy tests.
>
> K
>
>
> Sent via BlackBerry by AT&T
>
> -----Original Message-----
> From: "Gross, Ronald" <Ronald.Gross at baystatehealth.org>
>
> Date: Tue, 14 Apr 2009 09:03:28
> To: 'Trauma &amp; Critical Care mailing list'<trauma-list at trauma.org>
> Subject: RE: TEG forTrauma Patients
>
>
> We are actively looking at using TEG here at BMC, having been brought into the loop by a friend and former Army buddy, Phil Spinella (worked with Holcomb et all extensively on the 1:1:1 resuscitation algorithms).  We are going over the data - and the budget - and  I am hoping to have it in the ED and ICU by year's end.
>
> Ron
>
> -----Original Message-----
> From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of Sise, Mike MD
> Sent: Tuesday, April 14, 2009 8:26 AM
> To: trauma-list at trauma.org
> Subject: TEG forTrauma Patients
>
> Who has experience with the TEG for trauma patients? Our cardiac surgeons have been using it for three years and we are trialing it for managing major trauma resuscitations. Preliminary results are very promising. We also have been impressed with its ability to detect hypercoaguable states and to focus VTE prevention measures.
>
> Mike Sise
> San Diego
>
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