The Role of Thromboelastography Testing in the Emergency Medicine, Trauma Center, and Critical Care Environments
Author:
Publisher
Springer Science and Business Media LLC
Subject
General Medicine
Link
http://link.springer.com/article/10.1007/s40138-018-0151-z/fulltext.html
Reference22 articles.
1. • Da Luz L, Nascimento B, Shankarakutty A, Rizoli S, Adhikari N. Effect of thromboelastography (TEG®) and rotational thromboelastometry (ROTEM®) on diagnosis of coagulopathy, transfusion guidance and mortality in trauma: descriptive systematic review. Crit Care. 2014;18(5). Predictive performance not superior to routine testing. Some early coagulopathies found that cannot be seen on routine testing. A ROTEM-based transfusion protocol decreased need for blood products but not associated with lower mortality rates.
2. •• Kreitzer N, Bonomo J, Kanter D, Zammit C. Review of thromboelastography in neurocritical care. Neurocrit Care. 2015;23(3):427–33. Limitations to the use of TEG—Patients who have serial TEG studies should be run on the same machine with the same activator. This requires calibration two to three times per day by personnel who are trained in the maintenance of TEG. TEG values reported at one institution do not represent values reported at another institution. Another drawback may be in the use of kaolin. Kaolin is a standardized agent that activates clotting through the contact activation (intrinsic) pathway. Monoanalysis with kaolin does not distinguish coagulopathy secondary to dilution from that of thrombocytopenia. Thus, algorithms based on the use of kaolin alone may lead to unnecessary transfusion of platelets. TEG is unable to provide information such as a platelet count, so the combination of aggregometric and viscoelastic methods is recommended for completeness.
3. • Quarterman C, Shaw M, Johnson I, Agarwal S. Intra- and inter-centre standardisation of thromboelastography (TEG®). Anaesthesia. 2014;69(8):883–90. Thromboelastography (TEG®; Haemonetics, Braintree, MA, USA) is one point-of-care method of assessing coagulation. A sample of whole blood is pipetted into a cup into which a torsion wire is suspended. The cup oscillates, and as the blood begins to clot, the oscillation is conducted to the wire. With increasing clot strength, there is increasing conduction of oscillation. The kinetics of the change in the oscillation of the wire are recorded graphically as the thromboelastograph (Fig. 1) [5]. The TEG is considered to reflect the process of clotting and fibrinolysis, as well as the availability and function of clotting factors, platelets, and fibrinogen. R time and K time has significant variability of results when performed by a single or multiple operators. Blood in citrated form had better consistency of results. Maxamplitude and alpha angle were consistent throughout. Variability may be due to mixing with kaolin.
4. Whiting D, DiNardo JA. TEG and ROTEM: technology and clinical applications. Am J Hematol. 2014;89(2):228–32. https://doi.org/10.1002/ajh.23599 .
5. Bolliger D, Seeberger MD, Tanaka KA. Principles and practice of thromboelastography in clinical coagulation management and transfusion practice. Transfus Med Rev. 2012;26(1):1–13. https://doi.org/10.1016/j.tmrv.2011.07.005 .
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