Evaluation of the altitude impact on a point-of-care thromboelastography analyzer measurement: prerequisites for use in airborne medical evacuation courses

Abstract

Purpose

Hemorrhagic shock is the first cause of preventable death in combat. Evacuations of wounded by aircraft are increasingly used and severely injured patients can spend consequent time in the air, mostly during strategic evacuation. In these situations, monitoring of blood coagulation may be pivotal in the management of blood product transfusion. Viscoelastic-guided transfusion is relevant in these situations. However, evaluation of these devices used in aircraft is lacking, especially the impact of decreased atmospheric pressure. The aim of this study is to evaluate the performance of an easy-to-carry viscoelastic system (TEG® 6s, Haemonetics).

Methods

First, TEG® 6s repeatability, reproducibility, and correlation with chronometric methods and TEG-5000 were assessed on quality controls, healthy volunteers, and patients. Secondly, we tested the influence of vibrations and altitude on TEG® 6s parameters (0ft vs. 8000 ft = 2428 m) and on quality control samples (normal and hypocoagulable).

Results

TEG® 6s exhibited good correlation with the reference method and TEG® 5000. Repeatability and reproducibility CVs were satisfactory. The tests performed in the hypobaric chamber revealed that performance at 0 ft and 8000 ft (2428 m) for 9 out of 13 parameters was not significantly different. However, we showed a significant increasing of CRT.Alpha (p = 0.049), CK.Alpha, CK.MA (p < 0.001 and p < 0.01, respectively) and CFF.MA increased (p < 0.05).

Conclusion

Our study provides proof of concept to validate testing in an actual aeromedical situation. Indeed, TEG® 6s appears to ease of use, resistance to high altitude conditions, and reliability on healthy humans. It is necessary to carry out a study on hemorrhagic injured patients in an aircraft.

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References

  1. 1.

    Travers S, Carfantan C, Luft A, Aigle L, Pasquier P, Martinaud C, et al. Five years of prolonged field care: prehospital challenges during recent French military operations. Transfusion (Paris). 2019;59:1459–66.

    Article  Google Scholar 

  2. 2.

    Kauvar DS, Lefering R, Wade CE. Impact of hemorrhage on trauma outcome: an overview of epidemiology, clinical presentations, and therapeutic considerations. J Trauma Inj Infect Crit Care. 2006;60:S3–11.

    Article  Google Scholar 

  3. 3.

    Chang R, Eastridge BJ, Holcomb JB. Remote damage control resuscitation in austere environments. Wilderness Environ Med. 2017;28:S124–S134134.

    Article  Google Scholar 

  4. 4.

    Gruen RL, Brohi K, Schreiber M, Balogh ZJ, Pitt V, Narayan M, et al. Haemorrhage control in severely injured patients. Lancet. 2012;380:1099–108.

    Article  Google Scholar 

  5. 5.

    Henriksen HH, Rahbar E, Baer LA, Holcomb JB, Cotton BA, Steinmetz J, et al. Pre-hospital transfusion of plasma in hemorrhaging trauma patients independently improves hemostatic competence and acidosis. Scand J Trauma Resusc Emerg Med. 2016. https://doi.org/10.1186/s13049-016-0327-z.

    Article  PubMed  PubMed Central  Google Scholar 

  6. 6.

    Holcomb JB. Damage control resuscitation. J Trauma Inj Infect Crit Care. 2007;62:S36–S3737.

    Article  Google Scholar 

  7. 7.

    Cotton BA, Faz G, Hatch QM, Radwan ZA, Podbielski J, Wade C, et al. Rapid thrombelastography delivers real-time results that predict transfusion within 1 hour of admission. J Trauma Inj Infect Crit Care. 2011;71:407–17.

    Article  Google Scholar 

  8. 8.

    Dias JD, Lopez-Espina CG, Ippolito J, Hsiao H, Zaman F, Muresan AA, et al. Rapid point-of-care detection and classification of direct-acting oral anticoagulants (DOACs) with the TEG® 6s: implications for trauma and acute care surgery. J Trauma Acute Care Surg. 2019;87(2):364–70.

    CAS  Article  Google Scholar 

  9. 9.

    Gonzalez E, Moore EE, Moore HB, Chapman MP, Chin TL, Ghasabyan A, et al. Goal-directed hemostatic resuscitation of trauma-induced coagulopathy: a pragmatic randomized clinical trial comparing a viscoelastic assay to conventional coagulation assays. Ann Surg. 2016;263:1051–9.

    Article  Google Scholar 

  10. 10.

    Shackelford SA, Del Junco DJ, Powell-Dunford N, Mazuchowski EL, Howard JT, Kotwal RS, et al. Association of prehospital blood product transfusion during medical evacuation of combat casualties in afghanistan with acute and 30-day survival. JAMA. 2017;318:1581–91.

    Article  Google Scholar 

  11. 11.

    Vitalis V, Carfantan C, Montcriol A, Peyrefitte S, Luft A, Pouget T, et al. Early transfusion on battlefield before admission to role 2: a preliminary observational study during “Barkhane” operation in Sahel. Injury. 2018;49:903–10.

    CAS  Article  Google Scholar 

  12. 12.

    Scott R, Burns B, Ware S, Oud F, Miller M. The reliability of thromboelastography in a simulated rotary wing environment. Emerg Med J. 2018;35(12):739–42.

    PubMed  Google Scholar 

  13. 13.

    Meledeo MA, Peltier GC, McIntosh CS, Voelker CR, Bynum JA, Cap AP. Functional stability of the TEG 6s hemostasis analyzer under stress. J Trauma Acute Care Surg. 2018;84:S83–S8888.

    CAS  Article  Google Scholar 

  14. 14.

    Dias JD, Haney EI, Mathew BA, Lopez-Espina CG, Orr AW, Popovsky MA. New-generation thromboelastography: comprehensive evaluation of citrated and heparinized blood sample storage effect on clot-forming variables. Arch Pathol Lab Med. 2017;141:569–77.

    Article  Google Scholar 

  15. 15.

    Streijger F, Lee JHT, Manouchehri N, Melnyk AD, Chak J, Tigchelaar S, et al. Responses of the acutely injured spinal cord to vibration that simulates transport in helicopters or mine-resistant ambush-protected vehicles. J Neurotrauma. 2016;33:2217–26.

    Article  Google Scholar 

  16. 16.

    Gill M. The TEG®6s on shaky ground? A novel assessment of the TEG®6s performance under a challenging condition. J Extra Corpor Technol. 2017;49:26–9.

    PubMed  PubMed Central  Google Scholar 

  17. 17.

    Martin D, Pate J, Vercueil A, Doyle P, Mythen M, Grocott M, et al. Reduced coagulation at high altitude identified by thromboelastography. Thromb Haemost. 2012;107:1066–71.

    CAS  Article  Google Scholar 

  18. 18.

    Roberts TR, Jones JA, Choi J-H, Sieck KN, Harea GT, Wendorff DS, et al. Thromboelastography on-the-go: evaluation of the TEG 6s device during ground and high-altitude aeromedical evacuation with extracorporeal life support. J Trauma Acute Care Surg. 2019;87:S119–S12727.

    Article  Google Scholar 

  19. 19.

    Sperry JL, Guyette FX, Brown JB, Yazer MH, Triulzi DJ, Early-Young BJ, et al. Prehospital plasma during air medical transport in trauma patients at risk for hemorrhagic shock. N Engl J Med. 2018;379:315–26.

    Article  Google Scholar 

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Acknowledgements

The authors would like to thank Philip Gray and Joao Dias from Haemonetics for providing the TEG 6s units/cartridges as well as providing technical support and advice prior to, during, and after this study.

Funding

Haemonetics provided TEG® 6s reagents and analyzers.

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Authors

Contributions

CM and JB designed the study, collected, analyzed, and interpreted data, and wrote the manuscript. MB and CP provided a critical revision of the manuscript.

Corresponding author

Correspondence to Christophe Martinaud.

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The authors declare that they have no competing interests.

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Boyé, M., Boissin, J., Poyat, C. et al. Evaluation of the altitude impact on a point-of-care thromboelastography analyzer measurement: prerequisites for use in airborne medical evacuation courses. Eur J Trauma Emerg Surg (2020). https://doi.org/10.1007/s00068-020-01420-2

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Keywords

  • Thromboelastography
  • Altitude
  • Temperature
  • Sensitivity