Thromboelastography On-the-Go: Evaluation of the TEG 6s Device During Ground and High-Altitude Aeromedical Evacuation with Extracorporeal Life Support

Background Coagulation monitoring capabilities during transport are limited. Thromboelastography (TEG) is a whole-blood clotting test measuring clot formation, stabilization and fibrinolysis; and is traditionally performed in a laboratory. We evaluated a new point-of-care TEG analyzer, TEG 6s (Haemonetics; Braintree, MA), in a large animal model of combat-relevant trauma managed with extracorporeal life support (ECLS) during ground and high-altitude aeromedical evacuation. The objective was to compare TEG 6s used during transport vs. the predicate device, TEG 5000, used in the laboratory. We hypothesized that TEG 6s would be comparable to TEG 5000 during dynamically changing transport conditions. Methods TEG parameters (R, K, Angle, MA, LY30) derived by TEG 6s and TEG 5000 were compared during transport of 8 swine. TEG 6s was transported with animals during ground transport and flight. TEG 5000 was stationary in an adjacent building. TEG 6s activated clotting time (ACT) was compared to a Hemochron Junior ACT analyzer (Accriva Diagnostics; San Diego, CA). Statistics were performed using SAS 9.4 with Deming regressions, Spearman correlations and average differences compared. Results Correlation between devices was stronger at sea-level (R r=0.7413, K r=0.7115, Angle r=0.7192, MA r=0.8386, LY30 r=0.9099) than during high-altitude transport (R r=0.4787, K r=0.4007, Angle r =0.3706, MA r=0.6573, LY30 r=0.8481). Method agreement was comparable during stationary operation (R r=0.7978, K r=0.7974, Angle r=0.7574, MA r=0.7841, LY30 r=0.9140) vs. ground transport (R r=0.7927, K r=0.6246, Angle r=0.6967, MA r=0.9163, LY30 r=0.8603). TEG 6s ACT trended higher than Hemochron ACT when subjects were heparinized (average difference=1442±1703 sec) without a methodological difference by Deming regression. Conclusions Mobile TEG 6s during ground and altitude transport is feasible and provides unprecedented information to guide coagulation management. Future studies should assess the precision and accuracy of TEG 6s during transport of critically ill. Level of Evidence Basic science paper, does not require level of evidence. Correspondence: Teryn R. Roberts, MS; Address: 2509 Kennedy Circle Bldg 125, 2nd Floor, San Antonio, TX 78235; Phone: (210)-619-7086; Email: troberts@genevausa.org Address for Reprints: Same as corresponding author Conflict of Interest: No conflicts declared. This study was funded by the United States Air Force and administered through the 59th Medical Wing via the Geneva Foundation under Contract #FA8650-15-C-6692, PI: Dr. Andriy Batchinsky, MD. List of Meetings where the Paper was Presented: 2017 Military Health System Research Symposium, Kissimmee, FL, 27-30 August 2017; and 34th Annual Children’s National Symposium: ECMO & The Advanced Therapies for Cardiovascular and Respiratory Failure, Keystone, CO, 25 February – 1 March 2018. No funding was received from the National Institutes of Health (NIH), Wellcome Trust, or the Howard Hughes Medical Institute (HHMI). © 2019 Lippincott Williams & Wilkins, Inc.

from Emergency Medicine via xlomafota13 on Inoreader http://bit.ly/2DoQQXL