ROTEM®-guided coagulation factor concentrate therapy in trauma: 2-year experience in Venice, Italy

Table 1 Details of bleeding trauma patients receiving ROTEM^®-guided coagulation factor concentrate treatment

			ROTEM^® parameters on arrival			Haemostatic treatment administered in response to initial ROTEM^® assessment				ROTEM^® parameters following haemostatic treatment
			EXTEM		FIBTEM						EXTEM		FIBTEM
	ISS on arrival	CT (seconds)	A10 (mm)	MCF (mm)	MCF (mm)	Prothrombin complex concentrate (IU)	Fibrinogen concentrat	Tranexamic acid (g)	Platelet concentrate (U)	CT (seconds)	A10 (mm)	MCF (mm)	MCF (mm)	Outcome
1	25	130	31	44	3	2,000	6	2	0	65	42	54	12	Survived
2	25	75	37	48	5	0	2	0	0	N/A	N/A	N/A	N/A	Survived
3	34	59	54	62	10	0	1	0	0	N/A	N/A	N/A	N/A	Survived
4	43	70	35	43	3	0	3	0	0	40	32	34	10	Survived^a
5	34	95	40	51	7	500	2	0	0	62	42	54	8	Survived^a
6	25	167	18	29	2	1,000	5	2	2	62	39	50	10	Survived
7	66^b	216^c	14^c	22^c	0	1,000	7	2	2	59	38	51	13	Died^d
8	66^b	139^c	22^c	34^c	0	2,000	8	2	2	74	26	38	8	Died^d
9	34	71	46	56	10	0	3	0	0	61	56	65	14	Survived
10	27	170	20	32	3	1,500	6	2	2	50	39	50	12	Survived
11	45	102	28	37	5	1,500	3	2	1	48	53	63	12	Died^f
12	36	114	20	29	5	1,500	4	2	1	61	39	48	9	Survived^a

A10, clot amplitude (firmness) 10 minutes after clotting time (CT); EXTEM, extrinsically activated thromboelastometric test; FIBTEM, thromboelastometric test of fibrin-based clotting; ISS, injury severity score; IU, international units; MCF, maximum clot firmness; N/A, not available. ^aPatient received platelets following the second ROTEM^® assessment. ^bFulminant hyperfibrinolysis was detected, so aprotinin-controlled thromboelastometric test (APTEM) parameters were initially used to guide treatment. Both patients also received fresh frozen plasma after the second ROTEM^® assessment. ^cValue obtained using the APTEM assay. ^dCause of death was multiple organ failure. ^eCause of death was abdominal aortic rupture and unstoppable haemorrhage. ^fCause of death was brain death.