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Castellucci C, Malorgio A, Budowski AD, Akbas S, Kolbe M, Grande B, Braun J, Noethiger CB, Spahn DR, Tscholl DW, Roche TR
Coagulation Management of Critically Bleeding Patients With Viscoelastic Testing Presented as a 3D-Animated Blood Clot (The Visual Clot): Randomized Controlled High-Fidelity Simulation Study
Coagulation management of critically bleeding patients with viscoelastic testing presented as a 3D animated blood clot - The Visual Clot: A Randomized Controlled High-Fidelity Simulation Study
Clara Castellucci;
Amos Malorgio;
Alexandra Dinah Budowski;
Samira Akbas;
Michaela Kolbe;
Bastian Grande;
Julia Braun;
Christoph B. Noethiger;
Donat R. Spahn;
David W. Tscholl;
Tadzio Raoul Roche
ABSTRACT
Background:
Guidelines recommend using viscoelastic coagulation tests to guide coagulation management, but interpreting the results remains challenging. Visual Clot, a 3D animated blood clot, facilitates interpretation through a user-centered and situation awareness-oriented design.
Objective:
We aimed to compare the impact of two different display modalities of viscoelastic test results (Visual Clot and ROTEM®temograms) on the coagulation management of anesthesia teams in critical bleeding scenarios.
Methods:
This is the first study to test this technology in a high-fidelity simulation study, very close to clinical reality. We analyzed simulations with post hoc video analysis. The primary outcome was correct targeted coagulation therapy. time to targeted coagulation therapy. Secondary outcomes were time to targeted coagulation, confidence, and workload.
Results:
We analyzed fifty-nine simulations. Teams using Visual Clot were more likely to deliver the overall targeted coagulation therapy correctly (RR 1.56; 95% CI: 1.0 to 2.47; P=.053) and administered the first targeted coagulation product faster (HR: 2.58; 95% CI: 1.37 to 4.85; P=0.003). In addition, participants showed higher decision confidence with Visual Clot (OR 3.6; 95% CI: 1.49 to 8.71; P=.005). We found no difference in workload (coefficient -0.03; 95% CI: -3.08 to 2.88; P=.99).
Conclusions:
Using Visual Clot led to a more accurate and faster targeted coagulation therapy than using ROTEM®temograms. Therefore, we encourage all viscoelastic test manufacturers to augment result presentation with a user-centered, intuitive and easy-to-understand visualization in order to reduce unnecessary cognitive load and to enhance patient care. Clinical Trial: Business Management System for Ethics Committees Number Req-2021-01112
Citation
Please cite as:
Castellucci C, Malorgio A, Budowski AD, Akbas S, Kolbe M, Grande B, Braun J, Noethiger CB, Spahn DR, Tscholl DW, Roche TR
Coagulation Management of Critically Bleeding Patients With Viscoelastic Testing Presented as a 3D-Animated Blood Clot (The Visual Clot): Randomized Controlled High-Fidelity Simulation Study