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Introduction of point‐of‐care ROTEM testing in the emergency department of an Australian level 1 trauma centre and its effect on blood product use
Author(s) -
Bainbridge Frederick J,
Sinha Romi,
Tocchetti Rick,
Clarke Chris,
Martin Daniel,
Foo Ngee,
Palmer Cameron S,
Ellis Daniel Y
Publication year - 2021
Publication title -
emergency medicine australasia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.602
H-Index - 52
eISSN - 1742-6723
pISSN - 1742-6731
DOI - 10.1111/1742-6723.13767
Subject(s) - cryoprecipitate , thromboelastometry , medicine , fresh frozen plasma , blood product , emergency department , emergency medicine , point of care , packed red blood cells , point of care testing , blood transfusion , whole blood , anesthesia , platelet , surgery , nursing , psychiatry , immunology
Objective To assess whether the introduction of point‐of‐care rotational thromboelastometry (ROTEM) analysis influences blood product transfusion and coagulation management in a modern Australian level 1 trauma centre. Methods Retrospective blood transfusion data collection from all level 1 trauma patients with an Injury Severity Score (ISS) >12 presenting to the Royal Adelaide Hospital in 2016 and 2018. Evaluation of changes in blood product administration with the addition of point‐of‐care viscoelastic testing in the ED in 2018. Results A total of 774 patients were analysed with 380 in 2016 and 394 in 2018. Almost a quarter of all 2018 trauma patients (93/394) had ROTEM performed within 24 h of ED arrival, 42% of these having an ISS >25. There was a significant increase in the number of patients receiving cryoprecipitate following the introduction of ROTEM ( P = 0.01). In those receiving cryoprecipitate, there was a significant reduction in subsequent platelet and fresh frozen plasma use ( P < 0.001). Overall, there was a reduction in expenditure on red cells, platelets and fresh frozen plasma from 2016 to 2018. Conclusion Point‐of‐care ROTEM was performed in a small proportion of patients, mainly those with a higher ISS. ROTEM introduction in the ED altered blood product transfusion practices for major trauma patients with an ISS >12, leading to a potentially safer transfusion strategy and cost savings for key blood products.