Surgery & Traumatology
Hemorrhagic shock
Traumatic hemorrhage management involves a systematic approach to control bleeding and manage coagulopathy. Early identification and control of bleeding sources, balanced resuscitation, and management of trauma-induced coagulopathy (TIC) are crucial. Viscoelastic testing, such as thromboelastography (TEG) and rotational thromboelastometry (ROTEM), guides hemostatic therapy and optimizes outcomes.
Non-traumatic hemorrhage management in critically ill patients requires optimal transfusion practices. Evidence-based thresholds for red blood cell (RBC) transfusion and the use of plasma, platelets, and fibrinogen are essential. Viscoelastic testing helps guide transfusion strategies and minimize adverse events, ensuring patient-centered care.
Diagnostic tests for coagulopathy, including TEG and ROTEM, provide real-time assessments of coagulation status. These tests enable personalized resuscitation strategies, guiding blood product administration and hemostatic therapy. Integration into damage control resuscitation (DCR) protocols improves outcomes by correcting coagulopathy and reducing mortality in trauma patients. Evidence-based algorithms further enhance the effectiveness of ROTEM-guided bleeding management, reducing unnecessary transfusions and improving patient safety.
Traumatic hemorrhage
Traumatic hemorrhage
The European guideline on management of major bleeding and coagulopathy following trauma: sixth edition
Rolf Rossaint et al., Critical Care (2023)
What’s inside
This sixth edition of the European guideline provides updated recommendations for managing major bleeding and coagulopathy in trauma patients, emphasizing evidence-based practices.
Why it’s relevant
Major bleeding and coagulopathy are leading causes of preventable death in trauma patients, requiring timely and effective interventions.
Key focus
- Early identification and control of bleeding sources
- Strategies for balanced resuscitation and transfusion protocols
- Management of trauma-induced coagulopathy (TIC)
- Use of viscoelastic testing to guide hemostatic therapy
Takeaway
The guideline highlights a systematic approach to managing bleeding and coagulopathy, integrating early hemorrhage control, targeted resuscitation, and advanced monitoring to improve outcomes in trauma patients.
Non-traumatic hemorrhage
Non-traumatic hemorrhage
Transfusion strategies in bleeding critically ill adults: a clinical practice guideline from the European Society of Intensive Care Medicine
Alexander P. J. Vlaar et al., Intensive Care Medicine (2021)
What’s inside
This clinical practice guideline from the European Society of Intensive Care Medicine (ESICM) provides evidence-based recommendations for transfusion strategies in critically ill adults with bleeding.
Why it’s relevant
Optimal transfusion practices are crucial for managing bleeding in critically ill patients, balancing the risks of anemia and transfusion-related complications.
Key focus
- Thresholds for red blood cell (RBC) transfusion in bleeding patients
- Use of plasma, platelets, and fibrinogen in massive hemorrhage
- Role of viscoelastic testing (e.g., TEG, ROTEM) in guiding transfusion
- Strategies to minimize transfusion-related adverse events
Takeaway
The guideline emphasizes a patient-centered approach to transfusion, using evidence-based thresholds and advanced monitoring to optimize outcomes and reduce risks in critically ill bleeding patients.
Diagnostic tests for coagulopathy
TEG & ROTEM
The Role of TEG and ROTEM in Damage Control Resuscitation
Jason B. et al., Shock (2021)
What’s inside
This article explores the role of thromboelastography (TEG) and rotational thromboelastometry (ROTEM) in damage control resuscitation (DCR) for trauma patients, focusing on their utility in guiding hemostatic therapy.
Why it’s relevant
TEG and ROTEM provide real-time, dynamic assessments of coagulation, enabling personalized resuscitation strategies to manage trauma-induced coagulopathy (TIC) effectively.
Key focus
- Principles of TEG and ROTEM in assessing coagulation status
- Role in guiding blood product administration and hemostatic therapy
- Integration into DCR protocols for trauma patients
- Evidence supporting improved outcomes with TEG/ROTEM-guided resuscitation
Takeaway
The article highlights the value of TEG and ROTEM in optimizing DCR, enabling targeted interventions to correct coagulopathy and reduce mortality in trauma patients.
ROTEM
The role of evidence-based algorithms for rotational thromboelastometry-guided bleeding management
Klaus Görlinger et al., Korean Journal of Anesthesiology (2019)
What’s inside
This article discusses the use of evidence-based algorithms for rotational thromboelastometry (ROTEM)-guided bleeding management, focusing on their application in perioperative and critical care settings.
Why it’s relevant
ROTEM-guided algorithms enable personalized, goal-directed hemostatic therapy, improving outcomes in patients with bleeding disorders.
Key focus
- Principles of ROTEM and its parameters for coagulation assessment
- Development and implementation of ROTEM-based algorithms
- Clinical applications in cardiac surgery, trauma, and critical care
- Evidence supporting reduced transfusion requirements and improved outcomes
Takeaway
The article highlights the effectiveness of ROTEM-guided algorithms in optimizing bleeding management, reducing unnecessary transfusions, and enhancing patient safety.