Is major burn injury associated with coagulopathy? The value of thrombelastometry in the detection of coagulopathy in major burn injury: A prospective observational study

Issue title: Selected papers of the 39th Conference of the German Society for Clinical Microcirculation and Hemorheology, 6-7 November 2020, Hannover, Germany

Guest editors: B. Hiebl, A. Krüger-Genge and F. Jung

Article type: Research Article

Authors: Lonic, Daniel^{a; b; c; 1} | Heidekrueger, Paul I.^{a; c; 1} | Bosselmann, Talia^a | Niclas Broer, P.^c | Gertler, Ralph^d | Wolfgang Martin, Klaus^d | Prantl, Lukas^a | Ninkovic, Milomir^c | Giunta, Riccardo^e | Ehrl, Denis^{c; e; *}

Affiliations: [a] Department of Plastic, Hand, and Reconstructive Surgery, University Medical Center Regensburg, Germany | [b] Department of Plastic, Reconstructive and Aesthetic Surgery, Helios Hospital Munich West, Munich, Germany | [c] Department of Plastic, Reconstructive, Hand and Burn Surgery, Bogenhausen Academic Teaching Hospital, Munich, Germany | [d] Department of Anesthesiology and Intensive Care Medicine, Helios Hospital Munich West, Munich, Germany | [e] Department of Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilians-University Munich, Germany

Correspondence: [*] Corresponding author: Priv.-Doz. Dr. Denis Ehrl, Department of Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilians-University Munich, Marcioninistr. 15, 81377 Munich, Germany. Tel.: +49 0 894 400 51214; Fax: +49 0 894 400 54401; E-mail: [email protected].

Note: [1] These authors contributed equally to the study

Abstract: BACKGRUND:The coagulation status of burn patients is generally impaired and is a major factor of the deteriorating burn patients’ overall situation. In trauma and other patient groups, the differential diagnosis of coagulation impairment has been largely improved by the use of rotational thromboelastometry (ROTEM®). The aim of this prospective observational study was the differentiated observation of coagulopathy in severely burned patients using standard parameters and ROTEM® thrombelastometry during the relevant stages of burn disease. PATIENTS AND METHODS:Twelve patients that sustained at least 20% third degree burns of total body surface area (TBSA) were included in the study. Standard and ROTEM® coagulation analyses were performed on admission and then twice daily during the first 14 days following burn trauma. RESULTS:Although the initial assessment of DIC was similar for both standard labs and ROTEM® measurements, more patients were detected to be in a state of worsening coagulation status for a longer time in ROTEM® than in standard measurements. In addition, one patient was rated in to be in decompensated DIC for 3 days according to ROTEM® measurements, while no patient was rated to be in a decompensated DIC based on standard parameters. CONCLUSION:This study points towards a more complex picture and higher occurrence of DIC in burn patients when thrombelastometric measurements like ROTEM® are taken into account in addition to standard coagulation parameters.

Keywords: Thrombelastometry, coagulation, burn injury

DOI: 10.3233/CH-209210

Journal: Clinical Hemorheology and Microcirculation, vol. 76, no. 2, pp. 299-308, 2020