The role of evidence-based algorithms for rotational thromboelastometry-guided bleeding management
- Author:
Klaus GÖRLINGER
1
;
Antonio PÉREZ-FERRER
;
Daniel DIRKMANN
;
Fuat SANER
;
Marc MAEGELE
;
Ángel Augusto Pérez CALATAYUD
;
Tae Yop KIM
Author Information
- Publication Type:Review
- Keywords: Algorithms; Bleeding management; Health care costs; Impedance aggregometry; Patient blood management; Thromboelastometry
- MeSH: Cooperative Behavior; Education; Health Care Costs; Hemorrhage; Humans; Interdisciplinary Communication; Methods; Mortality; Organization and Administration; Patient Safety; Point-of-Care Systems; Precision Medicine; Technology Assessment, Biomedical; Thrombelastography
- From:Korean Journal of Anesthesiology 2019;72(4):297-322
- CountryRepublic of Korea
- Language:English
- Abstract: Rotational thromboelastometry (ROTEM) is a point-of-care viscoelastic method and enables to assess viscoelastic profiles of whole blood in various clinical settings. ROTEM-guided bleeding management has become an essential part of patient blood management (PBM) which is an important concept in improving patient safety. Here, ROTEM testing and hemostatic interventions should be linked by evidence-based, setting-specific algorithms adapted to the specific patient population of the hospitals and the local availability of hemostatic interventions. Accordingly, ROTEM-guided algorithms implement the concept of personalized or precision medicine in perioperative bleeding management (‘theranostic’ approach). ROTEM-guided PBM has been shown to be effective in reducing bleeding, transfusion requirements, complication rates, and health care costs. Accordingly, several randomized-controlled trials, meta-analyses, and health technology assessments provided evidence that using ROTEM-guided algorithms in bleeding patients resulted in improved patient's safety and outcomes including perioperative morbidity and mortality. However, the implementation of ROTEM in the PBM concept requires adequate technical and interpretation training, education and logistics, as well as interdisciplinary communication and collaboration.
