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. 2022 Jan 12;11(2):356. doi: 10.3390/jcm11020356

Table 2.

Summary of literature investigating environmental influence on VHA accuracy.

Article Participants Type of Study and Setting Conclusions
Cundrle et al., 2013 [109] 30 civilians treated with hypothermia for ROSC after cardiac arrest Prospective Observational
Setting: St. Anne’s University Hospital Brno, Czech Republic
Temperature adjustment for kaolin TEG® or r-TEG® are of little clinical utility due to low precision of TEG® measurements; in vivo temperature TEG® analysis is unnecessary.
Hunt et al., 2015 [61] 430 military and civilian (3 total studies) Systematic Review and Meta-analysis Due to insufficient studies, the authors found no evidence on accuracy of TEG® and little evidence on accuracy of ROTEM® to diagnose TIC when compared to PT/INR.
Jeppesen et al., 2016 [110] 40 civilians treated with hypothermia for ROSC after OHCA Prospective Observational
Setting: Aarhus University Hospital, Denmark
At 33 °C, ROTEM® demonstrated a slower initiation of coagulation compared to 37 °C. The authors recommended that VHA analyses be maintained at 37 °C regardless of the patient’s body temperature.
Gill et al., 2017 [97] One healthy volunteer Comparative Methodological Analysis
Setting: Sydney Children’s Hospitals Network, New South Wales, Australia
With the TEG® 6 s, all measured parameters were significantly different while testing was subjected to motion.
Meledeo et al., 2018 [51] 3 healthy donors Prospective Observational
Setting: US Army Institute Surgical Research Blood Bank, San Antonio, Fort Sam Houston, Texas
TEG® 6 s was more robust against motion and temperature stresses compared to the ROTEM® delta and TEG® 5000. TEG® 6 s may be useful in austere environments.
Scott et al., 2018 [96] 148 TEG® 6 s samples (72 AW139 Helicopter flight simulators with CAE 3000-series, 76 ground) Comparative Analysis
Setting: Toll ACE Training Centre, Bankstown Airport, Sydney, NSW, Australia
TEG® 6 s was a reliable test in rotary wing flight conditions and demonstrated minimal variance compared to stable ground tests.
Roberts et al., 2019 [99] 8 swine on venovenous ECMO Comparative Analysis
Setting: San Antonio Military Medical Center, Fort Sam Houston, Texas
TEG® 6 s during ground or aeromedical transport is feasible; however, method agreement was stronger at sea level and while stationary compared to mobile ground or altitude transport.
Bates et al., 2020 [102] 8 healthy donors Prospective Observational
Setting: Gold Coast University Hospital ICU, Gold Coast, Queensland, Australia; and in a LifeFlight Retrieval Medicine operated Leonardo AW139 Helicopter
ROTEM® sigma and TEG® 6 s were unreliable during flight, however remained calibrated post-flight and provided sound results over time.
Boyé et al., 2020 [45] 3 healthy donors
15 military ICU patients
Comparative Analysis
Setting: ICU of the Military Medical Center Laveran (Marseille, France); simulated vibration at 100 Hz; simulated altitude of 8000 ft in a hypobaric chamber
TEG® 6 s parameters at simulated 0 ft and 8000 ft were consistent for 9 of 13 parameters. TEG® 6 s showed promise for aeromedical evacuation due to its ease of use and reliability.

INR, international normalized ratio; OHCA, out-of-hospital cardiac arrest; PT, prothrombin time; r-TEG®, rapid thromboelastography; ROSC, return of spontaneous circulation; ROTEM®, rotational thromboelastometry; TEG®, thromboelastometry; TIC, trauma-induced coagulopathy.