TEG in the real world

Know your weapons

Catherine Hurn SMACC 2013

3-4 points take away…

Some new vocabulary

As for TEGwhat it doeswhat it might doand what it doesn’t do

Vocabulary

ATC

ACoTS

TICTEG

ROTEM

ETIC

Vocabulary

ATC

ACoTS

TIC

ETIC

Acute traumatic coagulopathy

Trauma induced coagulopthy

Early trauma induced….

Acute coagulopathy of traumatic shock

Coagulopathy definition

1.5 times normal

INR 1.5, aPTT 60

INR 1.2

Brohi 2010

Maybe we just need another test…

Potential roles for TEG

1. Early diagnosis of coagulopathy2. Indicator of prognosis3. Guiding blood transfusion

1. Early diagnosis of coagulopathyATC characterized by reduced clot strength

2. Indicator of patient outcomes3 x more likely to receive transfusion70% required a MT

3. Guiding blood transfusion

Fig 1 Algorithm for goal-directed massive transfusion. The transfusion algorithm relies on thrombelastography (TEG) tracing variables to direct blood component therapy. <ce:italic> r-TEG,</ce:italic> Rapid TEG; <ce:italic> ACT,</ce:italic> acti...

Michael Pezold , Ernest E. Moore , Max Wohlauer , Angela Sauaia , Eduardo Gonzalez , Anirban Banerjee , Christophe...

Viscoelastic clot strength predicts coagulation-related mortality within 15 minutes

Surgery Volume 151, Issue 1 2012 48 - 54

http://dx.doi.org/10.1016/j.surg.2011.06.023

rTEG trace

Potential roles for TEG

1. Early diagnosis of coagulopathy2. Revealing patient prognosis3. Guiding blood transfusion4. Assess Dabigatran5. Assess risk for PE

In the real world…

ISSUES

TrickySmall cohortDud test results

Really POC?