J Emerg Trauma Shock. 2018 Oct-Dec;11(4):265-270. doi: 10.4103/JETS.JETS_134_17.

World Academic Council of Emergency Medicine Experience Document: Implementation of Point-of-Care Thromboelastography at an Academic Emergency and Trauma Center.

Wahlen BM¹, El-Menyar A^2,³, Peralta R⁴, Al-Thani H⁵.

Author information

1: Department of Anesthesia and Trauma Surgery, Hamad General Hospital, Doha, Qatar.
2: Department of Surgery, Trauma and Vascular Surgery, Clinical Research, Hamad General Hospital, Doha, Qatar.
3: Department of Clinical Medicine, Weill Cornell Medical College, Doha, Qatar.
4: Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar.
5: Department of Surgery, Trauma and Vascular Surgery, Hamad General Hospital, Doha, Qatar.

Abstract

Background:

We aimed to discuss the initial experience of the implementation of point-of-care thromboelastography (POC-TEG) at the Level 1 Trauma Center of an academic health institution in Qatar.

Materials and Methods:

A TEG protocol was developed and tailored to our hospital requirements and patient population, after an exhausting review of the literature and international published protocols, including a synthesis of a preexisting TEG protocol from our heart hospital. To successfully achieve the incorporation of point-of-care testing (POCT) in our clinical practice, a multidisciplinary organizational and education approach is required. The education and training of the physicians in this POCT modality during the first 3 months period has been described in detail.

Results:

A TEG protocol has been developed and implemented according to hospital standards. Ten physicians from the department of trauma surgery have been trained over a 3-month period to perform the daily quality control as well as the patient samples in order to provide a 24/7 service. In patients with major trauma, brain injury, bleeding, sepsis, and coagulopathy are the most important determinants of the clinical course and outcomes. Viscoelastic whole-blood assays have already proved their values in cardiac as well as liver surgery. Therefore, this POCT-directed approach would be considered as a part of the goal-directed management in severe polytrauma patients.

Conclusions:

Our experience shows that implementation of POC-TEG program is feasible and it is a promising tool in the management of major trauma patients with a potential compromised coagulation. However, further prospective research projects and well-trained personnel still warranted.