Thrombelastography (TEG® 6s) early amplitudes predict maximum amplitude in severely injured trauma patients
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Thrombelastography (TEG® 6s) early amplitudes predict maximum amplitude in severely injured trauma patients. / Vigstedt, Martin; Baksaas-Aasen, Kjersti; Henriksen, Hanne H.; Maegele, Marc; Stanworth, Simon; Juffermans, Nicole P.; Kolstadbråten, Knut M.; Naess, Pål A.; Brohi, Karim; Gaarder, Christine; Stensballe, Jakob; Johansson, Pär I.
In: Scandinavian Journal of Clinical and Laboratory Investigation, Vol. 82, No. 6, 2022, p. 508-512.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Thrombelastography (TEG® 6s) early amplitudes predict maximum amplitude in severely injured trauma patients
AU - Vigstedt, Martin
AU - Baksaas-Aasen, Kjersti
AU - Henriksen, Hanne H.
AU - Maegele, Marc
AU - Stanworth, Simon
AU - Juffermans, Nicole P.
AU - Kolstadbråten, Knut M.
AU - Naess, Pål A.
AU - Brohi, Karim
AU - Gaarder, Christine
AU - Stensballe, Jakob
AU - Johansson, Pär I.
N1 - Publisher Copyright: © 2022 Medisinsk Fysiologisk Forenings Forlag (MFFF).
PY - 2022
Y1 - 2022
N2 - Severely injured trauma patients are often coagulopathic and early hemostatic resuscitation is essential. Previous studies have revealed linear relationships between thrombelastography (TEG®) five- and ten-min amplitudes (A5 and A10), and maximum amplitude (MA), using TEG® 5000 technology. We aimed to investigate the performance of A5 and A10 in predicting low MA in severely injured trauma patients and identify optimal cut-off values for hemostatic intervention based on early amplitudes, using the cartridge-based TEG® 6s technology. Adult trauma patients with hemorrhagic shock were included in the iTACTIC randomized controlled trial at six European Level I trauma centers between 2016 and 2018. After admission, patients were randomized to hemostatic therapy guided by conventional coagulation tests (CCT) or viscoelastic hemostatic assays (VHA). Patients with available admission-TEG® 6s data were included in the analysis, regardless of treatment allocation. Low MA was defined as <55 mm for Kaolin TEG® and RapidTEG®, and <17 mm for TEG® functional fibrinogen (FF). One hundred eighty-seven patients were included. Median time to MA was 20 (Kaolin TEG®), 21 (RapidTEG®) and 12 (TEG® FF) min. For Kaolin TEG®, the optimal Youden index (YI) was at A5 < 36 mm (100/93% sensitivity/specificity) and A10 < 47 mm (100/96% sensitivity/specificity). RapidTEG® optimal YI was at A5 < 34 mm (98/92% sensitivity/specificity) and A10 < 45 mm (96/95% sensitivity/specificity). TEG® FF optimal YI was at A5 < 12 mm (97/93% sensitivity/specificity) and A10 < 15 mm (97/99% sensitivity/specificity). In summary, we found that TEG® 6s early amplitudes were sensitive and specific predictors of MA in severely injured trauma patients. Intervening on early amplitudes can save valuable time in hemostatic resuscitation.
AB - Severely injured trauma patients are often coagulopathic and early hemostatic resuscitation is essential. Previous studies have revealed linear relationships between thrombelastography (TEG®) five- and ten-min amplitudes (A5 and A10), and maximum amplitude (MA), using TEG® 5000 technology. We aimed to investigate the performance of A5 and A10 in predicting low MA in severely injured trauma patients and identify optimal cut-off values for hemostatic intervention based on early amplitudes, using the cartridge-based TEG® 6s technology. Adult trauma patients with hemorrhagic shock were included in the iTACTIC randomized controlled trial at six European Level I trauma centers between 2016 and 2018. After admission, patients were randomized to hemostatic therapy guided by conventional coagulation tests (CCT) or viscoelastic hemostatic assays (VHA). Patients with available admission-TEG® 6s data were included in the analysis, regardless of treatment allocation. Low MA was defined as <55 mm for Kaolin TEG® and RapidTEG®, and <17 mm for TEG® functional fibrinogen (FF). One hundred eighty-seven patients were included. Median time to MA was 20 (Kaolin TEG®), 21 (RapidTEG®) and 12 (TEG® FF) min. For Kaolin TEG®, the optimal Youden index (YI) was at A5 < 36 mm (100/93% sensitivity/specificity) and A10 < 47 mm (100/96% sensitivity/specificity). RapidTEG® optimal YI was at A5 < 34 mm (98/92% sensitivity/specificity) and A10 < 45 mm (96/95% sensitivity/specificity). TEG® FF optimal YI was at A5 < 12 mm (97/93% sensitivity/specificity) and A10 < 15 mm (97/99% sensitivity/specificity). In summary, we found that TEG® 6s early amplitudes were sensitive and specific predictors of MA in severely injured trauma patients. Intervening on early amplitudes can save valuable time in hemostatic resuscitation.
KW - Blood coagulation
KW - hemostasis
KW - shock
KW - thrombelastography
KW - trauma
U2 - 10.1080/00365513.2022.2119599
DO - 10.1080/00365513.2022.2119599
M3 - Journal article
C2 - 36073613
AN - SCOPUS:85138270514
VL - 82
SP - 508
EP - 512
JO - Scandinavian Journal of Clinical and Laboratory Investigation. Supplement
JF - Scandinavian Journal of Clinical and Laboratory Investigation. Supplement
SN - 0085-591X
IS - 6
ER -
ID: 329285495