Rotational thromboelastometry diagnostics and treatments in 9353 critically ill surgical and non-surgical intensive care patients; a single centre cohort study

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Abstract
BackgroundRotational thromboelastometry (ROTEM) provides a dynamic assessment of hemostasis in critically ill patients. However, observational studies evaluating ROTEM-guided therapeutic interventions in intensive care units (ICUs) are scarce.ObjectivesTo evaluate the use of ROTEM as routine protocolized care versus indication-based testing and its association with therapeutic interventions in ICU patients.MethodsA single-centre retrospective observational cohort study was conducted at Maastricht University Medical Centre+ between 2013 and 2024. ICU patients who underwent at least one ROTEM measurement were included. ROTEM findings and clinical interventions were compared across four patient groups: elective and emergency cardiothoracic surgery (CTS; routine protocolized ROTEM) and general surgery and non-surgical patients (indication-based ROTEM).ResultsA total of 9141 ICU patients were included: 6739 elective CTS, 489 emergency CTS, 1142 non-surgical, and 771 general surgery patients. Abnormal ROTEM results were more frequent in indication-based groups (39.9-41.9%) compared to routine-based groups (16.3-27.8%; p<0.001). Drug-based interventions and transfusions were also more common in clinically indication-based groups. Actual clinical interventions mirrored this distribution. ConclusionsROTEM abnormalities and associated therapeutic interventions were more frequent when testing was performed based on clinical indication, as compared to routine protocolized care. These findings suggest routine protocolized ROTEM testing in CTS patients is less effective than a strategy based on clinical indication.