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Korean J Anesthesiol > Epub ahead of print
DOI: https://doi.org/10.4097/kja.19169    [Epub ahead of print]
Published online May 17, 2019.
The role of evidence-based algorithms for rotational thromboelastometry-guided bleeding management
Klaus Görlinger1, Antonio Pérez-Ferrer2, Daniel Dirkmann1, Fuat Saner3, Marc Maegele4, Ángel Augusto Pérez Calatayud5, Tae-Yop Kim6
1Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany
2Department of Anesthesiology, Infanta Sofia University Hospital, San Sebastián de los Reyes, Madrid, Spain
3Department of General, Visceral and Transplant Surgery, University Hospital Essen, University Duisburg-Essen, Essen, Germany
4Department for Trauma and Orthopedic Surgery, Cologne-Merheim Medical Center (CMMC) and Institute for Research in Operative Medicine (IFOM), University Witten/Herdecke (UW/H), Campus Cologne-Merheim, Cologne, Germany
5Terapia Intensiva Adultos, Hospital de Especialidades del Niño y la Mujer, Coordinador Grupo Mexicano para el Estudio de la Medicina Intensiva, Colegio Mexicano de Especialistas en Obstetrica Critica (COMEOC), Queretarco, Mexico
6Department of Anesthesiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, South Korea
Corresponding author:  Klaus Görlinger, Tel: +49 89 45 42 95 69, 
Email: kgoerlinger@ilww.com
Received: 8 April 2019   • Revised: 8 May 2019   • Accepted: 8 May 2019
Abstract
Rotational thromboelastometry (ROTEM) is a point-of care viscoelastic method and enables to assess viscoelastic profiles of whole blood in various clinical settings. ROTEM-guided bleeding management has become an essential part of patient blood management (PBM) which is an important concept in improving patient safety. Here, ROTEM testing and hemostatic interventions should be linked by evidence-based, setting specific algorithms adapted to the specific patient population of the hospitals and the local availability of hemostatic interventions. Accordingly, ROTEM-guided algorithms implement the concept of personalized or precision medicine in perioperative bleeding management (‘theranostic’ approach). ROTEM-guided PBM has been shown to be effective in reducing bleeding, transfusion requirements, complication rates and health care costs. Accordingly, several randomized-controlled trials, meta-analyses and health technology assessments provided evidence that using ROTEM-guided algorithms in bleeding patients resulted in improved patient’s safety and outcomes including perioperative morbidity and mortality. However, the implementation of ROTEM in PBM concept requires adequate technical and interpretation training, education and logistics, as well as interdisciplinary communication and collaboration.
Key Words: Algorithms; Bleeding management; Cardiovascular surgery; Health care costs; Impedance aggregometry, Liver disease, Liver transplantation, Postpartum hemorrhage, Obstetrics, Patient blood management, Patient outcomes, Point-of-care testing, Trauma, Thrombo
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