Abstract
BACKGROUND: Despite advances in treatment, hemorrhage remains one of the leading causes of early death in trauma. Rapid, personalized treatment of coagulopathy in this population should therefore be a priority. The introduction of viscoelastic hemostatic assays may improve transfusion strategies. METHODS: This prospective observational study aimed to compare the efficacy of a ROTEM-guided hemostatic treatment protocol for trauma patients with a historical control group who had received conventional coagulation testing. The study included adults with multiple trauma requiring transfusion (≥ 1 unit of RBC within 12 h). The aim was to compare transfusion requirements in the operating room, on the 1st and 2nd ICU days, the rate of massive transfusion, and the overall outcome. The data obtained were stored in a database and analyzed using Statistica™ 13.3 (Stat Soft Polska). A p-value < 0.05 was considered significant. Study was registered retrospectively at researchregistry.com (RR10995). RESULTS: A total of 78 patients were compared. The number of RBC units transfused in the OR and on the 1st ICU day decreased significantly after implementation of the ROTEM treatment protocol (p = 0.01, p = 0.04). Fewer patients in the study group required RBC transfusion on the 1st and 2nd ICU days (p = 0.01, p = 0.003), as well as the number of patients requiring FFP transfusion in all examined periods of time (p = 0.02, p = 0.006, p = 0.01). While FFP use per patient in the OR and on the 1st ICU day was lower, it was not statistically significant. Fibrinogen substitution in the OR remained similar, but more patients from the study group received it on the 1st ICU day (13 vs. 5, p = 0.04). The need for other blood products and coagulation factors remained unchanged. MT incidence decreased significantly in the first 24 h (p = 0.02), while 30-day mortality remained unchanged. CONCLUSIONS: The introduction of the ROTEM- guided hemostatic treatment protocol in trauma resulted in a changes in transfusion requirements and a reduction in the incidence of MT. ROTEM can be a useful clinical tool in the rapid and targeted management of bleeding trauma patients. TRIAL REGISTRATION: Researchregistry.com (RR10995).