Targeting blood products transfusion in trauma: what is the role of thromboelastography?

Viscoelastic hemostatic assays (VHAs), mainly thromboelastography (TEG) and the rotational thromboelastometry (ROTEM), provide global information on clot formation and dissolution at patient bedside, allowing fast identification of coagulation disorders. In trauma patients, VHAs are able to predict massive transfusion and mortality. These devices might also be used for applying targeted administration of procoagulant factors (e.g. fibrinogen concentrate) as an alternative to or in addition to using predefined fixed ratios of red blood cells: platelets: fresh frozen plasma/cryoprecipitate. These goal-directed, individualized treatment algorithms seem to reduce blood product transfusion without deleterious effects on patient outcome. Nevertheless, a clear outcome benefit of using VHAs remains to be demonstrated in trauma patients.