State of the Art
Rotational Thromboelastometry (ROTEM) and Thromboelastography (TEG) are the two forms of viscoelastic testing currently in clinical use. Unlike conventional coagulation testing, such as prothombin time (PT), partial thromboplastin time (PTT), and measurements of platelet and fibrinogen levels, these viscoelastic tests provide information about clot formation in whole blood in rapid fashion at the bedside. This information can guide a tailored resuscitation in critical patients, but only if the treating team is familiar with their interpretation. The benefits of thromboelastometry have been evaluated in multiple scenarios, including trauma, GI bleeding, End-Stage Liver Disease, and postoperative complications. Unfortunately, despite a growing evidence base and clinical availability, thromboelastometry remains underutilized and poorly understood in comparison to conventional testing. These difficulties in test interpretation provide obstacles to the growth of viscoelastic testing in clinical use, but knowledge of its role is essential for the ED physician taking care of critically ill patients. This talk will explore the clinical role of ROTEM and TEG in the ED care of critically ill patients. Attendees will learn about the technology used by the test, the results that are generated, and how to interpret them to guide their choice of resuscitation products.