Transfusional Optimization Using Viscoelastic Test Guided Therapy in Major Obstetric Hemorrhage: Simulation and Skills

Abstract

Major obstetric hemorrhages are certainly one of the most complicated emergencies to manage from different points of view and despite all the medical efforts, they are still worldwide linked to high morbidity and mortality rates. Viscoelastic hemostatic arrays are finding a place in well-defined massive transfusion protocols day by day. These tests allow a fast bedside assessment of the coagulation status of the patient and there are growing evidences about the benefits of viscoelastic tests guided transfusion algorithms in terms of survival, optimization of the transfused blood products and reduction of the collateral effects related to overtreatment. In this chapter we describe the last evidences about the integration of these tests in order to guide the transfusional therapy in major obstetric hemorrhages, we further analyze their usefulness in association with the basic laboratory bundle and we propose the main developed algorithms for use into daily clinical practice.