The Other Side of the Coin: Using Rotational Thromboelastometry to Stop or Avoid Blood Transfusions in Trauma Patients

However, empiric resuscitation with early transfusion of large amounts of blood and blood products to severely injured patients has drawbacks.The correct time to initiate or to stop blood transfusion cannot be objectively determined, and most massive transfusion protocols (MTP) are initiated at the physician's discretion (gestalt).There are numerous scoring systems that assist physicians IntroductIonDespite the recent advances in the evaluation and management, coagulopathy and hemorrhage remain major causes of death and morbidity in trauma. 1 Trauma-induced coagulopathy (TIC) is an early event associated with shock (hypoperfusion) and tissue destruction (severity of trauma). 2 The recognition of the importance and frequency of TIC and the enormous modifications adopted to address it have led to a revolution in trauma resuscitation in the XXI century. 3 Crystalloid restriction and early transfusion of blood products aiming to correct hypovolemia and TIC are the new an widely-implemented standards of trauma resuscitation 4 .The ideal management of TIC, however, is still open to debate.Early PLS, PLT, and RBC concentrate in preestablished ratios of 1:1:2 (or 1:1:1), as well as the use of hemostatic agents such as tranexamic acid (TXA), are among the most widely adopted strategies. 4,5The role of static coagulation tests is debatable due to major limitations in diagnosing and guiding the early management of TIC in complex trauma patients.Consequently, most surgeons blindly initiate blood transfusions during early resuscitation of patients with apparent significant bleeding prior to confirming the diagnosis of TIC and irrespective of the lab coagulation tests.Despite only one out of four (25%) severely injured patients having TIC, empiric early blood product transfusion is widely accepted as the current gold standard for trauma resuscitation. 6