Redefining haemostasis: Role of rotational thromboelastometry in critical care settings

Figure 1  Fundamental concept of rotational thromboelastometry.

Figure 2 Rotational thromboelastometry tracing. CT: Clotting time; CFT: Clot formation time; MCF: Maximum clot firmness; LI 30%: The proportion of clot stability retained 30 minutes after clotting time, relative to the maximum clot firmness value; ML: Maximum lysis.

Figure 3 Rotational thromboelastometry-guided management with acute bleeding and an indication for blood transfusion. A: In trauma; B: In post-partum haemorrhage; C: In liver transplantation; D: In cardiac surgery. ACT: Activated clotting time; A5_EX: Amplitude of clot firmness 5 minutes after clotting time in EXTEM; A5_FIB: Amplitude of clot firmness 5 minutes after clotting time in fibrinogen thromboelastometry; BE: Base excess; CT_FIB: Clotting time in fibrinogen thromboelastometry; CT_IN: Clotting time in INTEM; CT_HEP: Clotting time in HEPTEM; FFP: Fresh frozen plasma; Hb: Hemoglobin; ISS: Injury severity score; LI30_EX: Lysis index at 30 minutes in EXTEM; LI60_EX: Lysis index at 60 minutes in EXTEM; ML: Maximum lysis; TASH: Trauma associated severe hemorrhage; PCC: Prothrombin complex concentrate; PPH: Post-partum hemorrhage.