Abstract

Severely injured trauma patients are often coagulopathic and early hemostatic resuscitation is essential. Previous studies have revealed linear relationships between thrombelastography (TEG^®) five- and ten-min amplitudes (A5 and A10), and maximum amplitude (MA), using TEG^® 5000 technology. We aimed to investigate the performance of A5 and A10 in predicting low MA in severely injured trauma patients and identify optimal cut-off values for hemostatic intervention based on early amplitudes, using the cartridge-based TEG^® 6s technology. Adult trauma patients with hemorrhagic shock were included in the iTACTIC randomized controlled trial at six European Level I trauma centers between 2016 and 2018. After admission, patients were randomized to hemostatic therapy guided by conventional coagulation tests (CCT) or viscoelastic hemostatic assays (VHA). Patients with available admission-TEG^® 6s data were included in the analysis, regardless of treatment allocation. Low MA was defined as <55 mm for Kaolin TEG^® and RapidTEG^®, and <17 mm for TEG^® functional fibrinogen (FF). One hundred eighty-seven patients were included. Median time to MA was 20 (Kaolin TEG^®), 21 (RapidTEG^®) and 12 (TEG^® FF) min. For Kaolin TEG^®, the optimal Youden index (YI) was at A5 < 36 mm (100/93% sensitivity/specificity) and A10 < 47 mm (100/96% sensitivity/specificity). RapidTEG^® optimal YI was at A5 < 34 mm (98/92% sensitivity/specificity) and A10 < 45 mm (96/95% sensitivity/specificity). TEG^® FF optimal YI was at A5 < 12 mm (97/93% sensitivity/specificity) and A10 < 15 mm (97/99% sensitivity/specificity). In summary, we found that TEG^® 6s early amplitudes were sensitive and specific predictors of MA in severely injured trauma patients. Intervening on early amplitudes can save valuable time in hemostatic resuscitation.

摘要

严重受伤的外伤患者常出现凝血障碍，早期止血复苏至关重要。^{以前的研究已经揭示了使用 TEG ®} 5000 技术的血栓弹力图 (TEG ^® ) 5 分钟和 10 分钟振幅（A5 和 A10）与最大振幅 (MA)之间的线性关系。^{我们旨在研究 A5 和 A10 在预测严重创伤患者低 MA 方面的性能，并使用基于墨盒的 TEG ®}根据早期振幅确定止血干预的最佳截止值6s技术。2016 年至 2018 年期间，在六个欧洲 I 级创伤中心进行的 iTACTIC 随机对照试验纳入了患有失血性休克的成人创伤患者。入院后，患者被随机分配接受常规凝血试验 (CCT) 或粘弹性止血试验 (VHA) 指导的止血治疗. 无论治疗分配如何，都将具有可用入院 TEG ^® 6s 数据的患者纳入分析。^{对于 Kaolin TEG ®}和 RapidTEG ^®，低 MA 定义为 <55 mm，对于 TEG ^®功能性纤维蛋白原 (FF)，定义为 <17 mm。包括 187 名患者。MA 的中位时间为 20 (Kaolin TEG ^® )、21 (RapidTEG ^® ) 和 12 (TEG ^®FF) 分钟。对于 Kaolin TEG ^®，最佳约登指数 (YI) 为 A5 < 36 mm（100/93% 灵敏度/特异性）和 A10 < 47 mm（100/96% 灵敏度/特异性）。RapidTEG ^®最佳 YI 为 A5 < 34 mm（98/92% 灵敏度/特异性）和 A10 < 45 mm（96/95% 灵敏度/特异性）。TEG ^® FF 最佳 YI 为 A5 < 12 mm（97/93% 灵敏度/特异性）和 A10 < 15 mm（97/99% 灵敏度/特异性）。总之，我们发现 TEG ^® 6s 早期振幅是严重创伤患者 MA 的敏感和特异性预测因子。干预早期振幅可以节省止血复苏的宝贵时间。