Diagnosis and Treatment of Trauma-Induced Coagulopathy by Viscoelastography
Jan Hartmann, Mark Walsh, Anne Grisoli, Anthony V. Thomas, Faisal Shariff, Ross McCauley, Stefani Vande Lune, Nuha Zackariya, Shivani Patel, Michael Farrell, Sherry Sixta, Robert March, E.P. Evans, Rebecca Tracy, Elena Campello, Ecaterina Scărlătescu, Vanessa Agostini, João D. Dias, Sarah Greve, Scott Thomas
Abstract
This article explores the application of viscoelastic tests (VETs) in trauma-induced coagulopathy and trauma resuscitation. We describe the advantages of VETs over conventional coagulation tests in the trauma setting and refer to previous disciplines in which VET use has reduced blood product utilization, guided prohemostatic agents, and improved clinical outcomes such as the mortality of critically bleeding patients. We describe different VETs and provide guidance for blood component therapy and prohemostatic therapy based on specific VET parameters. Because the two most commonly used VET systems, rotational thromboelastometry and thromboelastography, use different activators and have different terminologies, this practical narrative review will directly compare and contrast these two VETs to help the clinician easily interpret either and use the interpretation to determine hemostatic integrity in the bleeding trauma patient. Finally, we anticipate the future of new viscoelastic technologies that can be used in this setting.