Rotational Thromboelastometry (ROTEM®) to investigate the effects of hypothermia in patients with major burns undergoing early burn excision

Dr Chris Wearn1, Dr Robert Marriot1, Dr Elizabeth Concannon1, Dr Patrick  Coghlan1, Dr Nicholas Solanki1, A/Prof Marcus Wagstaff1

1Royal Adelaide Hospital Burns Service, Adelaide, Australia

Agenda:

Background:

Rotational thromboelastometry (ROTEM®) is a point of care (POC) test that has guided transfusion requirements in cardiac and liver transplantation for 20 years. Evidence is emerging that ROTEM® guided transfusion management may reduce blood product transfusions and mortality in trauma patients (Bugaev et al., 2020). A single prospective RCT has shown that a ROTEM® guided bleeding management algorithm may reduce blood transfusion requirement during burn excision surgery (Schaden et al., 2012). We aimed to perform a pilot study to investigate the use of ROTEM® in a small cohort of burn injured patients >20% TBSA and specifically investigate changes in clotting function with hypothermia in patients undergoing early burn excision.

Methods:

Data was retrospectively collected on a series of patients admitted with burns >20% TBSA who underwent ROTEM® analysis to assist with coagulation and bleeding management. Data was also collected on demographics, intra-operative core-temperature (IDC probe) and administration of blood products. Hypothermia was defined as a core temperature <36 Degrees centigrade.

Results:

Four patients were included in the pilot study in the study period January 2020 – July 2021. Mean burn TBSA was 46 (+/-27) % and mean age was 40 (+/- 13) years. Two patients (50%) presented with hypothermia to the Emergency dept. ROTEM® analysis was performed on admission for all patients and the results were correlated with patient core temperature data.

Conclusions:

A pilot study of ROTEM® analysis in a small cohort of patients with major burns was performed. Further prospective study is required to assess the utility of ROTEM® guided coagulation management for patients undergoing early major burn excision.

References

Bugaev N, Como JJ, Golani G, Freeman JJ, Sawhney JS, Vatsaas CJ, Yorkgitis BK, Kreiner LA, Garcia NM, Aziz HA, Pappas PA, Mahoney EJ, Brown ZW, Kasotakis G. Thromboelastography and rotational thromboelastometry in bleeding patients with coagulopathy: Practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2020 Dec;89(6):999-1017

Schaden E, Kimberger O, Kraincuk P, Baron DM, Metnitz PG, Kozek-Langenecker S. Perioperative treatment algorithm for bleeding burn patients reduces allogeneic blood product requirements. Br J Anaesth. 2012 Sep;109(3):376-81


Biography:

Dr Wearn is recently commenced a one year Burns Fellowship at the Royal Adelaide Hospital Burns Service as part of his final year of UK plastic surgery training. He has a background in Burns Research, having completed a PhD from the University of Birmingham in the UK.

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