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Review
. 2016 Jul-Sep;19(3):516-20.
doi: 10.4103/0971-9784.185546.

Simulation in coagulation testing using rotational thromboelastometry: A fast emerging, reliable point of care technique

Klaus Gorlinger  1 , Vandana Bhardwaj  2 , Poonam Malhotra Kapoor  2
Affiliations
Review

Simulation in coagulation testing using rotational thromboelastometry: A fast emerging, reliable point of care technique

Klaus Gorlinger et al. Ann Card Anaesth. 2016 Jul-Sep.

Abstract

Computer simulations can come in handy to train medical personnel with necessary skills to face the clinical scenarios involving various coagulopathies. Now a days, point of care (POC) devices such as thromboelastography, Sonoclot analyzer and newly approved rotational thromboelastometry (ROTEM) with faster results to assess coagulopathies are available on bedside of patients. ROTEM is emerging as a quick, portable, and well-validated device to evaluate coagulopathy in critical care and perioperative setup. A novel platelet-aggregometry integrated module enables simultaneous analysis of platelets as well as coagulation tests on the same screen. The entire gamut of POC signature curves obtained with different coagulation defects can be learned with graphical simulations. These simulations can be a valuable strategy to elucidate latent conditions, for which simulation interventions can then be designed to mimic different clinical scenarios.

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Figures

Figure 1
Figure 1
ROTEM device with integrated platelet-aggregometry module. ROTEM device containing 4 independendent channels in lower pannel for carrying out simultaneous different ROTEM tests (INTEM/EXTEM/FIBTEM/HEPTEM) and 2 channels in upper pannel for impedence aggregometry tests. ROTEM platelet assays (ARATEM/ADPTEM/TRAPTEM) are used to study effect on various platelet inhibior drugs. ROTEM: Rotational thromboelastometry
Figure 2
Figure 2
Different ROTEM graphs with various reagents. Various ROTEM tests like (a) EXTEM (activator, tissue factor with polybrene); APTEM (EXTEM plus activator, aprotinin, or tranexamic acid) (b) FIBTEM (EXTEM plus activator, cytochalasin D) (c) INTEM (activator, ellagic-acid) (d) HEPTEM (INTEM plus activator heparinase) and ECATEM (activator, ecarin) are possible simultaneously with the use of different reagents. ROTEM: Rotational thromboelastometry
Figure 3
Figure 3
Variables of ROTEM in TEMogram. The graphical representation (TEMogram) of clot amplitude (mm) against time (min) showing various ROTEM variables. ROTEM: Rotational thromboelastometry. TEMogram: Thromboelastometer-graphs
See this image and copyright information in PMC

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