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FIBTEM provides early prediction of massive transfusion in trauma
Sch?chletal.CriticalCare2011,15:R265
/content/15/6/R265
RESEARCH
OpenAccess
FIBTEMprovidesearlypredictionofmassive
transfusionintrauma
HerbertSch?chl1,2*,BryanCotton3,KenjiInaba4,UlrikeNienaber5,HenrikFischer6,WolfgangVoelckel2and
CristinaSolomon1,7
Abstract
Introduction:Predictionofmassivetransfusion(MT)amongtraumapatientsisdifficultintheearlyphaseof
traumamanagement.Whole-bloodthromboelastometry(ROTEM?)testsprovideimmediateinformationaboutthe
coagulationstatusofacutebleedingtraumapatients.WeinvestigatedtheirvalueforearlypredictionofMT.
Methods:ThisretrospectivestudyincludedpatientsadmittedtotheAUVATraumaCentre,Salzburg,Austria,with
aninjuryseverityscore≥16,fromwhombloodsamplesweretakenimmediatelyuponadmissiontothe
emergencyroom(ER).ROTEM? analyses(extrinsically-activatedtestwithtissuefactor(EXTEM),intrinsically-activated
testusingellagicacid(INTEM)andfibrin-basedextrinsicallyactivatedtestwithtissuefactorandtheplatelet
inhibitorcytochalasinD(FIBTEM)tests)wereperformed.Wedividedpatientsintotwogroups:massivetransfusion
(MT,thosewhoreceived≥10unitsredbloodcellconcentratewithin24hoursofadmission)andnon-MT(those
whoreceived0to9units).
Results:Of323patientsincludedinthisstudy(78.9%male;medianage44years),78wereincludedintheMT
groupand245inthenon-MTgroup.ThemedianinjuryseverityscoreuponadmissiontotheERwassignificantly
higherintheMTgroupthaninthenon-MTgroup(42vs27,P0.0001).EXTEMandINTEMclottingtimeandclot
formationtimeweresignificantlyprolongedandmaximumclotfirmness(MCF)wassignificantlylowerintheMT
groupversusthenon-MTgroup(P0.0001forallcomparisons).OfpatientsadmittedwithFIBTEMMCF0to3
mm,85%receivedMT.ThebestpredictivevaluesforMTwereprovidedbyhemoglobinandQuickvalue(area
underreceiveroperatingcurve:0.87forbothparameters).Similarlyhighpredictivevalueswereobservedfor
FIBTEMMCF(0.84)andFIBTEMA10(clotamplitudeat10minutes;0.83).
Conclusions:FIBTEMA10andFIBTEMMCFprovidedsimilarpredictivevaluesformassivetransfusionintrauma
patientstothemostpredictivelaboratoryparameters.Prospec
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