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Session 2: Oral Abstracts

O007 / #385: ROTEM GUIDED MANAGEMENT OF HAEMORRHAGE IN CHILDREN PRESENTING TO AN AUSTRALIAN MAJOR TRAUMA CENTRE

George, S.1,,2,,3; King, M.3; Jansen, M.4; Wake, E.5; Sweeny, A.3; Winearls, J.6

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doi: 10.1097/01.pcc.0000738136.34748.0f
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Aims & Objectives: A paediatric Major Haemorrhage Protocol (MHP) has been in place at our hospital since 2014, including a Paediatric ROTEM guided transfusion algorithm (Figure 1). Aim: To describe the use of ROTEM in the critically bleeding paediatric population at an Australian Major Trauma Centre Objective: To establish rates of acute traumatic coagulopathy identified by our algorithm

Methods: A retrospective review of electonic data extracts of blood product usage, ROTEM results and trauma presentations was undertaken for the period 29 May 2014 until 31 December 2017. Data linkage between the electronic medical record, blood-bank and trauma registry information systems was undertaken.

Results: In the dataset 171 children had a ROTEM performed for traumatic injury. Most children had a single ROTEM (141/171,82.5%), with 14/171(8.2%) having 2 ROTEMs and 16/171 (9.4%) requiring 3 or more ROTEM tests. Hyperfibrinolysis meeting treatment threshold was detected in 37/171 children (31.6%). Hypofibrinogenaemia meeting treatment threshold was detected in 56/171 (47.9%). Initial haemoglobin and platelets were normal for most trauma presentations (88% and 96%). Standard laboratory coagulation profiles were available for 132/171(77.2%), with the first measured fibrinogen level reported as <2g/L in 17/132(12.8%).

Conclusions: The use of ROTEM at the point-of-care in paediatric major hamorrhage is an emerging practice. The adoption of ROTEM guided MHP into paediatric practice may improve the early detection of coagulation deficiencies and allow for more targeted replacement of coagulation factors, with the potential for more efficent control of non-surgical bleeding along with reducing waste and exposure to blood products that are not specifically indicated nor required.

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