Redefining haemostasis: Role of rotational thromboelastometry in critical care settings

Abstract

Management of patients with acute hemorrhage requires addressing the source of bleeding, replenishing blood volume, and addressing any coagulopathy that may be present. Assessing coagulopathy and predicting blood requirements in real-time in patients experiencing ongoing bleeding can pose substantial challenges. In these patients, transfusion concepts based on ratios do not effectively address coagulopathy or reduce mortality. Moreover, ratio-based concepts do not stop bleeding; instead, they just give physicians more time to identify the bleeding source and plan management strategies. In clinical practice, standard laboratory coagulation tests (SLCT) are frequently used to assess various aspects of blood clotting. However, these tests may not always offer a comprehensive understanding of clinically significant coagulopathy and the severity of blood loss. Furthermore, the SLCT have a considerable turnaround time, which may not be ideal for making prompt clinical decisions. In recent years, there has been a growing interest in point-of-care viscoelastic assays like rotational thromboelastometry, which provide real-time, dynamic information about clot formation and dissolution.

Keywords: Bleeding; Critical care; Haemorrhage; Intensive care unit; Rotational thromboelastometry; Viscoelastic tests

Core Tip: Point of care viscoelastic tests like rotational thromboelastometry (ROTEM) can provide real-time, dynamic information about clot formation and dissolution and prove to be a valuable tool for assessing coagulation in numerous critical care settings. Unlike traditional coagulation tests, ROTEM can provide whole-blood evaluations which may aid the physicians to quickly identify coagulation issues and administer targeted treatments. With emerging technology and increasing clinical experience, new applications may emerge, and ROTEM may become an integral part of modern haemostatic management.