Study supports efficacy of thromboelastography for hemostatic resuscitation in pelvic fracture cases

Investigators of this study found that for guidance in the acute phase of hemostatic resuscitation, thromboelastography with platelet mapping was useful for real-time evaluation of the coagulation status of patients with polytrauma with pelvic injuries.

“Adequate resuscitation of trauma patients is a dynamic challenge with numerous contributing variables,” Christiaan N. Mamczak, DO, told Healio.com/Orthopedics. “The adjunctive use of thromboelastography (TEG) with platelet mapping (PM) yields the most comprehensive analysis of a patient’s coagulation status; namely, their capacity to form and maintain a stable clot in response to trauma (ie, pelvic fracture). TEG with PM guides acute trauma resuscitation with individualized transfusions of necessary component blood products rather than reliance upon an empiric 1:1:1 ratio of [packed red blood cells] PRBCs, platelets and [fresh frozen plasma] FFP. Thus, TEG with PM offers transfusions of only the blood products trauma patients require without unnecessary transfusion wastage. The return of a normal TEG tracing also serves as a surrogate for adequate resuscitation.”

Christiaan N. Mamczak

Mamczak and colleagues retrospectively reviewed 40 multiply injured patients with acute pelvic fractures and acetabular fractures. Investigators treated patients with standard care and TEG with PM in order to guide the initialization of 24-hour resuscitation. Patients were also reviewed for demographics, mechanism of injury, calculated base deficit, TEG/ PM parameters, injury severity score, initial 24-hour survival, number of days in the intensive care unit or hospital surgery treatment, angiography use and units of component blood products transfused overall. Pelvic fracture types and differences among the component blood products transfused were compared.

Results showed transfusion of at least one blood product occurred in 90% of patients. Investigators found 84% of transfusions occurred 6 hours after admission. Compared with FFP, TEG/PM resulted in a higher volume of platelets and PRBCs. Investigators noted the average transfusion ratio for PRBC:FFP:platelet was 2.5:1:2.8. According to researchers, there were more transfusion requirements in patients with combined injuries compared with patients who had either pelvic ring fractures or acetabular fractures; however, this difference was not significant.

“We still do not know the absolute indications for TEG with PM in orthopedics, but our study highlights its value in managing acute trauma patients with pelvic injuries. Further research is certainly necessary” Mamczak said. ‒ by Monica Jaramillo

Reference:

Mamczak CN, et al. J Orthop Trauma. 2016;doi:10.1097/BOT.0000000000000537.

Disclosure: Mamczak reports no relevant financial disclosures.