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Minerva Anestesiologica 2014 December;80(12):1320-35


language: English

Thromboelastometry for guiding bleeding management of the critically ill patient: a systematic review of the literature

Haas T. 1, Görlinger K. 2, Grassetto A. 3, Agostini V. 4, Simioni P. 5, Nardi G. 6, Ranucci M. 7

1 Department of Paediatric Anaesthesia, University Children’s Hospital Zurich, Zurich, Switzerland; 2 Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, Essen, Germany; 3 UOC Anestesia e Rianimazione, Dipartimento di Emergenza Urgenza, Ospedale dell’Angelo di Mestre, Venice, Italy; 4 Struttura Dipartimentale di Medicina Trasfusionale Ospedale Bufalini USL Cesena, Italy; 5 Department of Cardiologic, Thoracic, and Vascular Sciences, 2nd Chair of Internal Medicine, University of Padua Medical School, Padova, Italy; 6 UOC Shock e Trauma, Azienda Ospedaliera S. Camillo-Forlanini, Roma, Italy; 7 Department of Cardiothoracic and Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy


A systematic review of the published literature clearly demonstrates the usefulness of thromboelastometry (ROTEM®) in detecting coagulation disorders in severe trauma, cardiac and aortic surgery, liver transplantation, and postpartum haemorrhage reliably and within a clinically acceptable turn-around time. In all of the above-mentioned scenarios, the transfusion of any allogeneic blood products could be reduced significantly using ROTEM®-guided bleeding management, thereby minimising or avoiding transfusion-related side effects. Based on the current body of evidence as assessed by the GRADE system, the use of ROTEM® may be recommended in particular for management of severe bleeding after trauma and during cardiac and aortic surgery. However, as laboratory testing contributes only one part of severe bleeding management, the implementation of safe and effective treatment algorithms must be ensured at the same time.

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