Rotational Thromboelastometry: Enhancing Hemostasis Monitoring in Anesthesia

Authors

  • Girishkumar Modi DA, DNB Tawam Hospital,Tawam, Abu Dhabi, UAE
  • Vijay Kumar DA, DNB Tawam Hospital,Tawam, Abu Dhabi, UAE
  • Nagaraju Munagala DA, DNB Tawam Hospital,Tawam, Abu Dhabi, UAE

DOI:

https://doi.org/10.17140/RPAOJ-7-137

Keywords:

ROTEM®, Thrombelastography (TEG), Anesthesia, Hemostasis, Trauma, PPH, Acute bleeding

Abstract

Rotational thromboelastometry (ROTEM) is a viscoelastic point-of-care coagulation test that measures the dynamics of clot formation and lysis in whole blood samples. A cylindrical shaft that oscillates while passing through a tiny amount of blood is used in the procedure. Blood exerts increasing pressure on the shaft as it thickens into a clot. We can track the strength of the forming clot over time by measuring this resistance. ROTEM® can provide valuable information about the coagulation status of patients who are at risk of bleeding or thrombosis in various peri-operative settings, such as trauma, obstetrics, cardiac surgery, liver transplantation, and major orthopedic and vascular surgeries. In addition, it can aid in the diagnosis and treatment of peri-operative coagulopathy, reduce unneeded transfusions, and enhance patient outcomes.

References

Scharrer I, Schramm W, eds. 31st Haemophilia Symposium. Berlin, Germany: Springer Berlin, Heidelberg; 2001: doi: 10.1007/978-3- 642-59383-3

Da Luz LT, Nascimento B, Shankarakutty AK, Rizoli S, Ad-hikari NK. Effect of thromboelastography (TEG®) and rotational thromboelastometry (ROTEM®) on diagnosis of coagulopathy, transfusion guidance and mortality in trauma: Descriptive system-atic review. Crit Care. 2014; 18(5): 518. doi: 10.1186/s13054-014- 0518-9

Tokuda NH, Richards C, Lockhart E, Crookston KP. Emergen-cy hemorrhage panel implementation decreases rotational throm-boelastometry (ROTEM) use for transfusion decisional support. American Journal of Clinical Pathology. 2018; 150(suppl_1): S148. doi: 10.1093/ajcp/aqy112.350

Görlinger K, Pérez-Ferrer A, Dirkmann D, et al. The role of evi-dence-based algorithms for rotational thromboelastometry-guided bleeding management. Korean J Anesthesiol. 2019; 72(4): 297-322. doi: 10.4097/kja.19169

Whiting D, DiNardo JA. TEG and ROTEM: Technology and clinical applications. Am J Hematol. 2014; 89: 228-232. doi: 10.1002/ ajh.23599

He S, Eelde A, Petrini P, et al. A ROTEM method using APTT reagent and tissue factor as the clotting activators may better de-fine bleeding heterogeneity in moderate or severe haemophilia A (part I: Study in plasma samples). Thromb Res. 2018; 171: 7-13. doi: 10.1016/j.thromres.2018.09.041

Kelly JM, Rizoli S, Veigas P, Hollands S, Min A. Using rotational thromboelastometry clot firmness at 5 minutes (ROTEM® EX-TEM A5) to predict massive transfusion and in-hospital mortality in trauma: A retrospective analysis of 1146 patients. Anaesthesia. 2018; 73(9): 1103-1109. doi: 10.1111/anae.14297

Meesters MI, Lancé MD, van der Steeg R, Boer C. The value of the thromboelastometry heparinase assay (HEPTEM) in cardiac surgery. Thromb Haemost. 2015; 114(5): 1058-1063. doi: 10.1160/ TH15-01-0066

Seeßle J, Löhr J, Kirchner M, et al. Rotational thrombelastom-etry (ROTEM) improves hemostasis assessment compared to con-ventional coagulation test in ACLF and Non-ACLF patients. BMC Gastroenterol. 2020; 20: 271. doi: 10.1186/s12876-020-01413-w

Al Moosawi M, Trudeau J, Smith T, Lefebvre A, Shih AW. ROTEM in the setting of liver transplant surgery reduces frozen plasma transfusion. Transfus Apher Sci. 2021; 60(3): 103125. doi: 10.1016/j.transci.2021.103125

Bell SF, Roberts TCD, Pereira JFM, et al. The sensitivity and specificity of rotational thromboelastometry (ROTEM) to detect coagulopathy during moderate and severe postpartum haemor-rhage: A prospective observational study. Int J Obstet Anesth. 2022; 49: 103238. doi: 10.1016/j.ijoa.2021.103238

McNamara H, Kenyon C, Smith R, Mallaiah S, Barclay P. Four years’ experience of a ROTEM®-guided algorithm for treatment of coagulopathy in obstetric haemorrhage. Anaesthesia. 2019; 74: 984-991. doi: 10.1111/anae.14628

Brill JB, Brenner M, Duchesne J, et al. The role of TEG and ROTEM in damage control resuscitation. Shock. 2021; 56(1S): 52- 61. doi: 10.1097/SHK.0000000000001686

Salehi M, Bola R, de Jong N, Shih AW, Garraway N, Dawe P. Guided blood transfusion of trauma patients with rotational thromboelastometry: A single-center cohort study. World J Emerg Surg. 2023; 18(1): 40. doi: 10.1186/s13017-023-00508-5

Smith AR, Karim SA, Reif RR, et al. ROTEM as a predictor Submit your article to this journal | https://openventio.org/submit-manuscript/ of mortality in patients with severe trauma. J Surg Res. 2020; 251: 107-111. doi: 10.1016/j.jss.2020.01.013

Veigas PV, Callum J, Rizoli S, et al. A systematic review on the rotational thrombelastometry (ROTEM®) values for the diag-nosis of coagulopathy, prediction and guidance of blood transfu-sion and prediction of mortality in trauma patients. Scand J Trauma Resusc Emerg Med. 2016; 24: 114. doi: 10.1186/s13049-016-0308-2

Deppe AC, Weber C, Zimmermann J, et al. Point-of-care throm-boelastography/thromboelastometry-based coagulation manage-ment in cardiac surgery: A meta-analysis of 8332 patients. J Surg Res. 2016; 203(2): 424-33. doi: 10.1016/j.jss.2016.03.008

ROTEM® delta US-Operating-Manual. 2013. Website. https:// www.sfgh-poct.org/wp-content/uploads/2013/02/ROTEM-delta-US-Operating-Manual-Part-12.pdf. Accessed September 15, 2023.

Collins PW, Bell SF, de Lloyd L, Collis RE. Management of postpartum haemorrhage: From research into practice, a narra-tive review of the literature and the Cardiff experience. Int J Obstet Anesth. 2019; 37: 106-117. doi: 10.1016/j.ijoa.2018.08.008

Schöchl H, Maegele M, Solomon C, et al. Early and individual-ized goal-directed therapy for trauma-induced coagulopathy. Scand J Trauma Resusc Emerg Med. 2012; 20: 15. doi: 10.1186/1757-7241- 20-15

Calatzis A, Gorlinger K, . Spannagl M, Vorweg M. ROTEM® Analysis Targeted Treatment of Acute Haemostatic Disorders. 2016. Website. https://www.ttuhsc.edu/medicine/odessa/inter-nal/documents/ttim-manual/ROTEM_Analysis.pdf. Accessed September 15, 2023.

NHS University Hospitals Sussex. ROTEM Interpretation. 2021. Website. https://www.bsuh.nhs.uk/library/wp-content/ uploads/sites/8/2021/12/ROTEM-interpretation.pdf. Accessed September 15, 2023.

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Published

2023-11-03

How to Cite

Girishkumar Modi, Vijay Kumar, & Nagaraju Munagala. (2023). Rotational Thromboelastometry: Enhancing Hemostasis Monitoring in Anesthesia. Research and Practice in Anesthesiology, 7(2), 21–30. https://doi.org/10.17140/RPAOJ-7-137

Issue

Vol. 7 No. 2 (2023): Volume 7 Issue 2 2023

Section

Articles

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