Rapid thromboelastography (TEG) can be used to guide resuscitation with blood products. It can guide specific patient needs. The authors are from the University of Colorado Denver.
Patient selection: adult with hypotension presumed to be due to acute blood loss
Analysis: citrated rapid-TEG
Parameters:
(1) activated clotting time (ACT) in seconds
(2) angle in degrees (alpha) for rate of clot strength increase
(3) maximum amplitude (MA) of clot strength in millimeters
(4) percent clot lysis at 30 minutes after maximum amplitude (LY30)
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Parameters
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Cutoff
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Transfuse
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activated clotting time
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> 128 seconds
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FFP
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angle in degrees
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< 65 degrees
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cryoprecipitate
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maximum amplitude
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< 55 mm
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platelets
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percent clot lysis LY30
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> 5%
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tranexamic acid
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Criteria for massive transfusion:
1) > 4 units of RBCs in any 60-minute period in the first 6 hours from injury
(2) > 10 units of RBCs in first 6 hours OR death in first 6 hours
Performance for recognition of massive transfusion:
• ACT: sensitivity 64%, specificity 67%
• LY30: sensitivity 54%, specificity 91%
• angle: sensitivity 70%, specificity 81%
• MA: sensitivity 70%, specificity 82%
