The review by Da Luz and colleagues in this issue of
Critical Care highlights the progress provided by thrombelastography (TEG
®) and thrombelastometry (ROTEM
®) in diagnosing and monitoring the coagulation system in trauma patients [
1]. Their systematic review includes 55 studies and over 12,000 patients and they find that early abnormalities in TEG
®/ROTEM
® predict massive transfusion need and mortality. However, they conclude that 'Effects on blood product transfusion, mortality and other patient-important outcomes remain unproven in randomized trials' [
1]. Formalistically this is of course correct; however, which monitoring system or laboratory value in medicine has ever improved relevant patient outcomes such as length of ICU or hospital stay, complications, treatment costs or even mortality? The answer is none, simply because a monitoring system or a laboratory value provides information allowing risk assessment but lacks any therapeutic potential.
TEG
®/ROTEM
® information, however, allows creation of goal-directed, individualized treatment algorithms that may improve patient outcome. This has been shown for TEG
®/ROTEM
®-based algorithms in prospective randomized studies in cardiac surgery [
2],[
3]. In liver transplantation such algorithms have even become standard. And the benefits are impressive: reduced transfusion needs, less complications, shorter length of ICU and hospital stay, better survival and reduced treatment costs [
2],[
3]. TEG
®/ROTEM
®-based algorithms have also been successful in improving patient outcome in trauma, although these studies were not prospective and randomized [
4]-[
6]. Nevertheless, the recommendation to use TEG
®/ROTEM
® in the treatment of severely injured trauma patients was upgraded in the 2013 European Trauma Treatment Guidelines from 2C to 1C with a plea to implement goal-directed, individualized treatment algorithms and to monitor treatment adherence [
4].
Competing interests
DRS's academic department receives grant support from the Swiss National Science Foundation, Berne, Switzerland, the Ministry of Health (Gesundheitsdirektion) of the Canton of Zurich, Switzerland for Highly Specialized Medicine, the Swiss Society of Anesthesiology and Reanimation (SGAR), Berne, Switzerland, the Swiss Foundation for Anesthesia Research, Zurich, Switzerland, Bundesprogramm Chancengleichheit, Berne, Switzerland, CSL Behring, Berne, Switzerland, Vifor SA, Villars-sur-Glâne, Switzerland. DRS was chairman of the ABC Faculty and is the co-chairman of the ABC-Trauma Faculty, which both are managed by Physicians World Europe GmbH, Mannheim, Germany and sponsored by unrestricted educational grants from Novo Nordisk Health Care AG, Zurich, Switzerland, CSL Behring GmbH, Marburg, Germany and LFB Biomédicaments, Courtaboeuf Cedex, France. In the past 5 years, DRS has received honoraria or travel support for consulting or lecturing from the following companies: Abbott AG, Baar, Switzerland, AMGEN GmbH, Munich, Germany, AstraZeneca AG, Zug, Switzerland, Bayer (Schweiz) AG, Zürich, Switzerland, Baxter AG, Volketswil, Switzerland, Baxter S.p.A., Roma, Italy, B Braun Melsungen AG, Melsungen, Germany, Boehringer Ingelheim (Schweiz) GmbH, Basel, Switzerland, Bristol-Myers-Squibb, Rueil-Malmaison Cedex, France and Baar, Switzerland, CSL Behring GmbH, Hattersheim am Main, Germany and Berne, Switzerland, Curacyte AG, Munich, Germany, Ethicon Biosurgery, Sommerville, New Jersey, USA, Fresenius SE, Bad Homburg v.d.H., Germany, Galenica AG, Bern, Switzerland (including Vifor SA, Villars-sur-Glâne, Switzerland), GlaxoSmithKline GmbH & Co. KG, Hamburg, Germany, Janssen-Cilag AG, Baar, Switzerland, Janssen-Cilag EMEA, Beerse, Belgium, Merck Sharp & Dohme AG, Luzern, Switzerland, Novo Nordisk A/S, Bagsvärd, Denmark, Octapharma AG, Lachen, Switzerland, Organon AG, Pfäffikon/SZ, Switzerland, Oxygen Biotherapeutics, Costa Mesa, CA, Photonics Healthcare GmbH, Munich, Germany, ratiopharm Arzneimittel Vertriebs-GmbH, Vienna, Austria, Roche Diagnostics International Ltd, Reinach, Switzerland, Roche Pharma (Schweiz) AG, Reinach, Switzerland, Schering-Plough International, Inc., Kenilworth, New Jersey, USA, Tem International GmbH, Munich, Germany, Verum Diagnostica GmbH, Munich, Germany, Vifor Pharma Deutschland GmbH, Munich, Germany, Vifor Pharma Österreich GmbH, Vienna, Austria, Vifor (International) AG, St. Gallen, Switzerland. None of the above listed companies and/or entities have been directly or indirectly involved in discussing and/or developing this manuscript or parts thereof. None of them have financially contributed to this endeavor in whatever form, either directly or indirectly. Therefore, it is beyond my capacity to tell whether any of the above listed companies and/or entities do or do not have a direct financial interest in the subject matter or materials discussed in this manuscript. Statement regarding support for the work: support was provided solely from institutional and/or departmental sources.