Practice algorithm of rotational thromboelastometry-guided bleeding management in trauma and orthopedic surgery

Severe traumatic injury continues to present challenges to health-care systems worldwide, and posttraumatic bleeding remains a leading cause of potentially preventable death among injured patients. Rotational thromboelastometry (ROTEM) is a point-of-care viscoelastic method and enables to assess viscoelastic profiles of whole blood in various clinical settings. ROTEM-guided patient blood management has been shown to be effective in reducing bleeding, transfusion requirements, complication rates, and health-care costs. Accordingly, several randomized-controlled trials, meta-analyses, and health technology assessments provided evidence that using ROTEM-guided algorithms in bleeding patients resulted in improved patient's safety and outcomes including perioperative morbidity and mortality. This document aims to provide practice algorithm on the management of major bleeding and coagulopathy following traumatic injury and encourages adaptation of the guiding principles described here to individual institutional circumstances and resources.