The Utility Of Thromboelastography In Acute Perioperative Trauma Resuscitation Of The Adult Coagulopathic Patient

One quarter of all patients admitted to level I trauma centers receive transfused blood, and approximately 25% of trauma transfusion recipients are diagnosed with coagulopathies during the resuscitation process (Hess et al., 2008; Kutcher & Cohen, 2021; Maegele et al., 2007). Such pathologies have been associated with negative clinical outcomes such as increased transfusion requirements, organ failure, sepsis, and death. (Barash et al., 2013; Cole et al., 2019; Hess et al., 2008; Sayce et al., 2020). Current laboratory standards of care to diagnose coagulopathies such as prothrombin time (PT), international normalized ratio (INR), and activated partial thromboplastin time (aPTT) are time consuming to obtain and may not reflect a trauma patient’s ongoing coagulation status (Baksaas-Aasen et al., 2020; Barash et al., 2013; Davenport et al., 2011). Consequently, point-of-care tests of hemostatic function such as thromboelastography (TEG) may be of use to the anesthesia provider. An examination of the history of TEG, review of the current literature, and analysis of future research directions has revealed certain limitations such as a potentially extensive clinician learning curve, minimal integration into existing hospital structures, and a lack of level-1 evidence. However, thromboelastography has the potential to optimize outcomes in the coagulopathic patient when used in conjunction with conventional coagulation tests—providing a complementary real-time graphic depiction of the poorly understood syndrome of trauma induced coagulopathy