Name of Faculty Advisor
Dr. Patricia Friend
Problem
Clinicians are seeking to provide more individualized care, especially in reducing hemorrhage related morbidity and mortality in trauma patients.
Purpose
Viscoelastic assays, specifically thromboelastography (TEG) and thromboelastometry (RoTEM), have been available since 1948 and have been used to assess clot formation, stability, and breakdown and have been well studied in the cardiac surgery and liver transplant populations. It has only recently been studied in the care of hemorrhaging trauma patients. Researchers propose that viscoelastic assays can identify life-threatening trauma-induced coagulopathy and guide transfusion practices.
Search strategy
PubMed was reviewed utilizing search terms "thromboelastography" and "trauma".
Results of literature search
Six articles were found that matched the search terms and investigated the impact of thromboelastography or thromboelastometry on the amount of blood products transfused.
Synthesis of evidence
Viscoelastic assay guided transfusion appears to help achieve hemostasis more efficiently when compared to fixed ratio massive transfusion protocol or protocols guided only by conventional coagulation studies. It is unclear if their use is the sole factor in reducing the number of blood products used and improving outcomes, especially in the studies where tranexamic acid was used. Additional research is needed to examine the impact of viscoelastic assays with and without tranexamic acid, as well as with and without clotting factor concentrates.
Implications for practice
Over-transfusion of blood has been associated with increased morbidity and mortality. It is also important to note that there has been considerable disruption in blood donation in the midst of the COVID-19 pandemic, leading to disruption in the availability of blood components. These disruptions show that now, more than ever, blood products should be used judiciously and equitably.
Staff nurses are in charge of the manner and pattern in which blood products are transfused, and are keenly aware of available supplies, especially in areas such as the operation room, intensive care unit, and emergency department. It is beneficial for these nurses to know about the use of viscoelastic assays. Likewise, advanced practice nurses should learn how to interpret the results of viscoelastic assays as they care for potentially coagulopathic patients, especially those such as surgical patients who may require distinction as coagulopathic or hemorrhaging and requiring re-exploration.
Can Viscoelastic Assays Reduce Blood Product Utilization in Hemorrhaging Trauma Patients?