Tromboelastograma con Rotem en el manejo de las hemorragias

Abstract

Early management of coagulopathy through transfusion protocols in massive bleeding optimizes results in victims. Rotational thromboelastography (ROTEM) analyzes the blood clot formation process through graphical and numerical representation, evaluating kinetics, formation, stability, solidity, and clot lysis in whole blood. Its primary advantage is the rapid response time. A systematic review was conducted to determine the importance of ROTEM in the bedside management of hemorrhages, according to the PRISMA 2020 guidelines. After reviewing the information, conclusions were drawn. Algorithms for hemorrhage management guided by ROTEM were determined. González et al. randomized trauma patients for a massive transfusion protocol guided by thromboelastometry (TEM) and conventional coagulation assays (CCA). The results at 28 days revealed a significant improvement in survival with the TEM-guided algorithm compared to the CCA algorithm (36.4% deaths vs. 19.6%; P = 0.049). Significant studies also exist for AC5 (sensitivity 70%, 95% CI, specificity 86%, 95% CI) and AC15 (sensitivity 88%, 95% CI, specificity 100%, 95% CI). Therefore, the importance of ROTEM in hemorrhage management was emphasized. These tests permit more selective and efficient transfusion therapy, reducing blood transfusions and mortality (P=0.04). No differences were found in surgical reintervention rates and massive transfusion rates. There is a cost-benefit advantage in using viscoelastic-based transfusion algorithms, leading to improved health results.