New Uses for Thromboelastography and Other Forms of Viscoelastic Monitoring in the Emergency Department: A Narrative Review - 20/02/21
, Lauren M. Yang, MD b, Samuel B. Snider, MD e, Adam B. Lerner, MD c, William C. Aird, MD d, Nathan I. Shapiro, MD, MPH aAbstract |
Patients frequently visit the emergency department with conditions that place them at risk of worse outcomes when accompanied by coagulopathy. Routine tests of coagulation—prothrombin time, partial thromboplastin time, platelets, and fibrinogen—have shortcomings that limit their use in providing emergency care. One alternative is to investigate coagulation disturbance with viscoelastic monitoring (VEM), a coagulation test that measures the timing and strength of blood clot development in real time. VEM is widely used and studied in cardiac surgery, liver transplant surgery, anesthesia, and trauma. In this article, we review the technique of VEM and the biologic rationale of using it in addition to routine tests of coagulation in emergency clinical situations. Then, we review the evidence (or lack thereof) for using VEM in the diagnosis and treatment of specific conditions. Finally, we describe the limitations of the test and future directions for clinical use and research in emergency medicine.
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| Supervising editor: Allan B. Wolfson, MD. Specific detailed information about possible conflict of interest for individual editors is available at editors. |
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| Author contributions: PDT, ABL, WCA, and NIS conceived the review. PDT drafted the manuscript, with major contributions from LMY and SBS. All authors contributed substantially to the original drafting and revisions. PDT and NIS take responsibility for the paper as a whole. |
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| All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
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| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). Dr. Shapiro is currently performing a research study with device and materials-only support from Entegrion, a company that produces viscoelastic monitoring devices; receives research funding from Baxter, Rapid Pathogen Screening, and the National Institutes of Health; and has received speaker and consultation fees from Baxter. |
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| A podcast for this article is available at www.annemergmed.com. |
Vol 77 - N° 3
P. 357-366 - mars 2021 Regresar al número
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