June 09, 2022
Trauma patients have unique needs. But one thing that is almost standard, no matter the type of injury or condition of the patient, is the need for blood or blood products.
“There is a saying in the trauma world, ‘All hypotension is caused from bleeding until proven otherwise.’ Blood products are the most effective resuscitation fluids for the trauma patient,” said Jeremy R. Timmer, MD, FACS, Trauma Medical Director.
Last year, RRMC saw 3,500 trauma patients with more than 300 Level I traumas (the patients who would benefit most from this technology.) Previously, physicians would send blood to the hospital’s lab and wait for several test results to come back. Even in a trauma situation, that could take as long as 20+ minutes.
Those results would tell the trauma team what type of blood products the patient needed – whether it be red blood cells, plasma, platelets or cryoprecipitate – and whether the patient had any blood thinners in their system that would interfere with natural clotting.
Now, this testing can be performed using thromboelastography technology (TEG). TEG monitors the “harmonic motion of blood in response to external vibrations.” As blood clots, the resonant frequency increases. TEG measures the change in frequency during clot formation and breakdown, and assesses platelet function and the effectiveness of anticoagulant and antiplatelet medications.
Results can be ready in 5-14 minutes. In addition, the information is presented as a graph. Depending on the shape and size of the graph, physicians can determine the best course of treatment for their patients, including the type of blood product needed.
“TEG can help streamline the resuscitation process and help prevent the use of un-needed blood products,” Dr. Timmer explained. “It can tell us if the problem is with platelets or with other blood products. It can also help us determine if patients who are on antiplatelet therapy are actually therapeutic or not, and prevent giving platelets if their native platelets are working.”
Rapides Regional Medical Center’s Laboratory implemented testing on three TEG6S analyzers in February 2022. After months of clinical training and education, TEG is now used during the first phase of trauma resuscitation in the emergency department, which helps physicians decide whether or not to begin Massive Transfusion Protocols.
Other trauma centers have seen a decreased need for blood products and a reduction in complications related to blood transfusion. Additionally, TEG has been used for traumatic brain injury patients, cardiovascular surgeries and patients in intensive care units. In those cases, studies have shown shorter hospital stays, fewer complications and decrease in mortality.
“This technology will help save lives,” Dr. Timmer said. “It will also help streamline the transfusions of very limited blood product resources to patients and therefore cut down on the amount of wasted blood products.
“Using TEG is on the verge of becoming the standard of care for trauma centers in regards to helping manage and guide resuscitations. This is the next step.”