Thrombelastography (TEG^® 6s) early amplitudes predict maximum amplitude in severely injured trauma patients

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.

Keywords:

• Blood coagulation
• hemostasis
• shock
• thrombelastography
• trauma

Disclosure statement

M. Vigstedt, K. Baksaas-Aasen, H.H. Henriksen, S. Stanworth, K.M. Kolstadbråten, P.A. Naess and J. Stensballe declare no conflicts of interest. M. Maegele has received honoraria for lectures and speakers’ bureaus, congress travel support as well as financial support for research projects from Astra Zeneca^®, Bayer^®, CSL Behring^®, IL-Werfen^®/TEM^® International, LFB Biomedicaments^® and Portola^®. N.P. Juffermans has received unrestricted research grants from Octapharma^® and CSL Behring^® and research support in the form of device and reagents from TEM^® International. K. Brohi has received research grant support from TEM^® International in the form of device and reagent support, and has previously served on external advisory panels for Haemonetics^® Corporation, TEM^® International, CSL Behring^®, Bayer^® and Astra Zeneca^®. C. Gaarder has received honoraria for lectures from Octapharma^® and research grant support from Haemonetics^® and TEM^® International in the form of device and reagent support. She has also previously served on the advisory board for Nycomed^®. P.I. Johansson has received unrestricted research grants from Haemonetics^® Corporation and Octapharma^®.

Data availability statement

Data can be obtained from the corresponding author upon reasonable request.

Additional information

Funding

The study was part of the ‘Targeted Action for Curing Trauma-Induced Coagulopathy’ (TACTIC) program, funded by the European Commission under the FP7 framework [Grant No. F3-2013-602771]. Both TEM^® International GmbH and Haemonetics^® Corporation were collaborating organizations in the TACTIC program. For this iTACTIC study, they provided the ROTEM^® Sigma and TEG^® 6s analyzers and all reagents to the relevant participating institutions. Neither these organizations nor any of their representatives had any role in the study design, data collection and analysis, decision to publish or preparation of the manuscript. This work was also supported by Seventh Framework Programme.