Using Rotational Thromboelastometry (ROTEM) at the point of care (POC) for bleeding burn patients reduces allogeneic blood product requirements, according to a new study.

Researchers at the Medical University of Vienna (Austria) conducted a prospective, randomized, controlled study that involved 30 consecutive patients undergoing surgical excision of burn wounds. Treatment was based on the Austrian standardized recommendation for the management of trauma–induced coagulopathy, using ROTEM at the POC. In the control group, coagulation management was performed according to the clinicians' discretion. The main outcome parameter was the cumulative number of allogeneic blood units transfused on the day of surgery.

The results showed that the difference between the groups regarding the cumulative use of allogeneic blood products was highly significant, with three blood products on average in the algorithm group, compared with nine in the control group. No plasma was administered in the algorithm group compared with a mean of five units overall in the control group. Fibrinogen concentrate administration was not significantly different between the groups, and tranexamic acid was not administered. The study was published on June 22, 2012, in the British Journal of Anesthesia.

“The significant reduction in allogeneic blood product requirements during surgical burn wound excision is a prospective proof of concept that a bleeding management algorithm based on thromboelastometry is efficacious,” concluded lead author Eva Schaden, MD, and colleagues of the department of anesthesia, general intensive care, and pain control. “Hypofibrinogenaemia and hyperfibrinolysis are not significant pathomechanisms of bleeding in this setting and ROTEM helps to avoid unnecessary interventions.”

ROTEM investigates the interaction of coagulation factors, their inhibitors, anticoagulant drugs, and blood cells (specifically platelets), during clotting and subsequent fibrinolysis. Testing is done in the presence of therapeutic heparin concentrations and provides differential diagnostic information to support decisions in therapy. The rapid testing of both hypo- and hyperfunctional stages of the clotting process helps to discriminate surgical bleeding from a true hemostatic disorder and improves the therapy with blood products, factor concentrates, anticoagulants and protamine, hemostyptic, and antifibrinolytic drugs.

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