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. 2021 Oct;33(5):893-899.
doi: 10.1111/1742-6723.13767. Epub 2021 Mar 17.

Introduction of point-of-care ROTEM testing in the emergency department of an Australian level 1 trauma centre and its effect on blood product use

Frederick J Bainbridge  1 , Romi Sinha  2 , Rick Tocchetti  3 , Chris Clarke  1 , Daniel Martin  4 , Ngee Foo  1 , Cameron S Palmer  5 , Daniel Y Ellis  1   4
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Introduction of point-of-care ROTEM testing in the emergency department of an Australian level 1 trauma centre and its effect on blood product use

Frederick J Bainbridge et al. Emerg Med Australas. 2021 Oct.

Abstract

Objective: To assess whether the introduction of point-of-care rotational thromboelastometry (ROTEM) analysis influences blood product transfusion and coagulation management in a modern Australian level 1 trauma centre.

Methods: Retrospective blood transfusion data collection from all level 1 trauma patients with an Injury Severity Score (ISS) >12 presenting to the Royal Adelaide Hospital in 2016 and 2018. Evaluation of changes in blood product administration with the addition of point-of-care viscoelastic testing in the ED in 2018.

Results: A total of 774 patients were analysed with 380 in 2016 and 394 in 2018. Almost a quarter of all 2018 trauma patients (93/394) had ROTEM performed within 24 h of ED arrival, 42% of these having an ISS >25. There was a significant increase in the number of patients receiving cryoprecipitate following the introduction of ROTEM (P = 0.01). In those receiving cryoprecipitate, there was a significant reduction in subsequent platelet and fresh frozen plasma use (P < 0.001). Overall, there was a reduction in expenditure on red cells, platelets and fresh frozen plasma from 2016 to 2018.

Conclusion: Point-of-care ROTEM was performed in a small proportion of patients, mainly those with a higher ISS. ROTEM introduction in the ED altered blood product transfusion practices for major trauma patients with an ISS >12, leading to a potentially safer transfusion strategy and cost savings for key blood products.

Keywords: cryoprecipitate; haemorrhage; rotational thromboelastometry; thromboelastography; trauma.

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