The influence of rotational thromboelastometry (ROTEM) on operating room and intensive care transfusion practices in major trauma bleeding: a prospective cohort study with historical control
Authors' conclusion
The introduction of the ROTEM- guided hemostatic treatment protocol in trauma resulted in a changes in transfusion requirements and a reduction in the incidence of MT.
Study context
- Population
- Adults with multiple trauma requiring transfusion (≥ 1 unit of RBC within 12 h)
- Participants
- 78 adults
- Exposure
- ROTEM vs Historical control
- Outcome
- Transfusion requirements in the OR and on the 1st and 2nd ICU days
Methodological detailsprospective observational, registered retrospectively
- Prospective observational
- Registered retrospectively
Main finding
As reported in the abstract
Transfusion requirements
- RBC units transfused in the OR decreased significantly with ROTEM protocol
- p = 0.01
- RBC units transfused on 1st ICU day decreased significantly with ROTEM protocol
- p = 0.04
- Fewer ROTEM patients required RBC transfusion on 1st ICU day
- p = 0.01
- Fewer ROTEM patients required RBC transfusion on 2nd ICU day
- p = 0.003
- Fewer ROTEM patients required FFP transfusion in all examined periods
- p = 0.02, p = 0.006, p = 0.01
Observational data: associations, not effects.
Further findings
RBC units transfused · OR and 1st ICU day
- Number of RBC units transfused in the OR and on the 1st ICU day decreased significantly after ROTEM protocol implementation
- P = 0.01, p = 0.04
Patients requiring RBC transfusion · 1st and 2nd ICU days
- Fewer patients in the study group required RBC transfusion on the 1st and 2nd ICU days
- P = 0.01, p = 0.003
Patients requiring FFP transfusion · all examined periods
- Fewer patients in the study group required FFP transfusion in all examined periods
- P = 0.02, p = 0.006, p = 0.01
FFP use per patient · OR and 1st ICU day
- FFP use per patient lower but not statistically significant
Fibrinogen substitution · 1st ICU day
- Patients receiving fibrinogen, study group vs control
- 13 vs. 5, p = 0.04
- Fibrinogen substitution in the OR similar
Other blood products and coagulation factors
- Need remained unchanged
MT incidence · first 24 h
- MT incidence decreased significantly
- P = 0.02
Mortality · 30 days
- 30-day mortality unchanged
Original publication
The influence of rotational thromboelastometry (ROTEM) on operating room and intensive care transfusion practices in major trauma bleeding: a prospective cohort study with historical control. Perioper Med (Lond). Published 21 July 2025. doi:10.
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