Rotational thromboelastometry (ROTEM) profile in a cohort of asystole donors

Abstract Background Hypoperfusion plays a central role in shock states, and has been proposed as a coagulopathy trigger. The study of the rotational thromboelastometry (ROTEM) profile during cardiac arrest could offer new insights to the role of hypoperfusion in coagulation during shock states. Outcome To describe the ROTEM profile in a cohort of asystole donors and elucidate the incidence of hyperfibrinolysis. Design A prospective observational study was carried out in 18 patients consecutively admitted to the ICU after out-of-hospital non-recovered cardiac arrest (CA). Initial rhythm and time between CA and admission were recorded. Conventional coagulation and ROTEM (EXTEM, APTEM, FIBTEM) tests were performed within 30 min after blood sample collection. Scope An asystole donor reference hospital. Participants Patients admitted to the ICU after out-of-hospital non-recovered CA. Results The median age was 50 years, and 14 of the patients were men (77.8%). The time from CA to hospital admission expressed as the median (interquartile range) was 91 min (75–104). The results of the routine tests were: INR 1.25 (1.19–1.34), aPTT 55 s (45–73) and fibrinogen 161 mg/dL (95–295). For the ROTEM APTEM assay the results were: CT 126 s (104–191), CFT 247 s (203–694). Hyperfibrinolysis criteria were recorded in 15 patients (83.3%). In addition, MCF improved in APTEM versus EXTEM. Prolonged CA times were associated to lower fibrinogen levels and lower values for MCF FIBTEM ( P Conclusions The ROTEM assays revealed severe alterations of the clot formation parameters and a high incidence of hyperfibrinolysis.