%0 Journal Article
%T The Role of Thrombelastography in Multiple Trauma
%A Victor Jeger
%A Heinz Zimmermann
%A Aristomenis K. Exadaktylos
%J Emergency Medicine International
%D 2011
%I Hindawi Publishing Corporation
%R 10.1155/2011/895674
%X Hemorrhage and traumatic coagulopathyis are major causes of early death in multiply injured patients. Thrombelastography (TEG) seems to be a fast and accurate coagulation test in trauma care. We suggest that multiply injured trauma patients would benefit the most from an early assessment of coagulation by TEG, mainly RapidTEG, to detect an acute traumatic coagulopathy and especially primary fibrinolysis, which is related with high mortality. This review gives an overview on TEG and its clinical applications. 1. Introduction Hemorrhage is a major cause of early death in multiply injured patients. One of the reasons of uncontrolled hemorrhage may be acute traumatic coagulopathy. It has been first discussed by Brohi and colleagues, and it is now thought to be induced by trauma and hypoperfusion [1, 2]. The pathomechanism of acute traumatic coagulopathy is extensively reviewed by Hess et al. [3] 25% of major trauma patients suffer from coagulopathy at admission to the hospital, and its presence is associated with a fourfold increase in mortality [2]. The initial treatment of bleeding trauma patients is not limited any more to damage control surgery but to damage control resuscitation, using a balanced administration of blood products in the ratio of red blood cells: fresh frozen plasma as 1£¿:£¿1 or 1£¿:£¿2, which is able to correct hypovolemia, anemia, and, to a certain degree, the acute traumatic coagulopathy [4, 5]. Additionally, the acute traumatic coagulopathy may also occur in absence of acute bleeding, for example, due to massive blunt injury and hypothermia. This pattern is typical for our patients population in a Level 1 trauma center in Switzerland, where we face mainly car accidents and injuries related to outdoor sports (skiing, climbing, base jumping, avalanches, etc.). In situations where coagulopathy is frequent but less obvious at admission of the patient to the resuscitation bay, the decisions should rely on evidence based point of care devices to correct coagulopathy. In reality, the trauma physician is somehow blinded to the current state of coagulation because of long turnover times of standard coagulation screening from the lab and he/she has to base decisions on experience and gut feeling [6]. The search for appropriate point of care devices in trauma care brought thrombelastography (TEG) back in focus in 1997 by Kaufmann et al. after the technique had been used for years in cardiac and liver surgery [7, 8]. 2. Thrombelastography¡ªAssessing the Viscoelastic Properties of the Thrombus The concept of thrombelastography had been first
%U http://www.hindawi.com/journals/emi/2011/895674/