​Abstract
Thromboelastometry (ROTEM®) is an advancement of the classical thromboelastography. Several technical enhancements made the device more robust and user-friendly, reduced intra- and inter-operator variability, and improved the diagnostic performance. This allows for using the device at the bedside in a mobile way and in a multiuser environment, even in military settings. The ROTEM® device is not only able to detect multiple aspects of trauma-induced coagulopathy (TIC) and disseminated intravascular coagulation (DIC), but it allows for prediction of bleeding, massive transfusion, thrombosis, and mortality, too. Furthermore, the ROTEM® device is designed to guide hemostatic therapy with allogeneic blood products (RBC, FFP, cryoprecipitate, and platelets) and in particular with specific coagulation factor concentrates (fibrinogen concentrate, prothrombin complex concentrate (PCC), factor XIII concentrate, and rFVIIa). Here, the combination of specific ROTEM® assays improved the diagnostic performance, significantly. Finally, the implementation of ROTEM®-guided bleeding management algorithms (“Theragnostic Approach”) has been shown to reduce transfusion requirements, complication rates, morbidity, mortality, and hospital costs in trauma and other clinical settings.

Lay SummaryOver 7000 Australians are treated for severe trauma every year. Major bleeding in the setting of trauma is associated with poor outcomes and increased rates of death. Severe trauma causes a decrease in the factors within the blood that helps clots to form and stop bleeding. This loss of clotting factors is associated with worse outcomes and it is proposed that early replacement of these factors may reduce bleeding and improve outcomes.
Fibrinogen is one of the key clotting factors that needs to be replaced in severe traumatic bleeding.
Fibrinogen concentrate (FC) is an alternative product used to assist in blood clotting. It is stored in powder form, can be reconstituted at the bedside and given quickly. The study will investigate whether it is quicker to administer FC than cryoprecipitate, which will reduce haemorrhage and improve outcomes. For more information see the link here