Outcomes
hyperfibrinolysis
CLOT
In this study, we distinguished between therapies that can be derived directly from the assessment of the viscoelastic test (targeted coagulation therapy) and other general coagulation management measures.Targeted coagulation therapy is defined as the administration of coagulation products whose indication can be derived solely from the Visual Clot or ROTEM temograms in the simulated scenarios. Overall coagulation therapy includes all therapeutic measures indicated for coagulation management in the respective scenario, including, but not limited to, those measures that can be derived from the Visual Clot or ROTEM temograms. The primary outcome was correct targeted coagulation therapy measured as the number of correct and complete therapeutic actions resulting solely from Visual Clot or ROTEM temograms interpretation.Secondary outcomes were defined as time to targeted coagulation therapy and correct overall coagulation therapy. The former was measured as the time in seconds from receiving Visual Clot or ROTEM temograms (standardized 5 minutes after scenario start) to administering the first correct targeted coagulation product. The latter we measured as the number of all correct therapeutic actions regarding coagulation management for the corresponding scenario. We abstained from assessing overall coagulation therapy, as teams had limited time and the number of necessary tasks to perform differed in each scenario.Finally, we examined participants’ perceived decision confidence (binary as confident or unconfident) and perceived workload during the simulations [Additionally, we asked the participants who used Visual Clot to rate 4 general statements about this technique on a 4-point Likert scale (Targeted and overall coagulation therapy per scenario. Please note that the items under targeted coagulation therapy are also part of the overall coagulation therapy. Please note that tranexamic acid was added to the overall coagulation therapy section because it is administered empirically in the coagulation algorithm of the study institution, even before rotational thrombelastometry (ROTEM) results are available. Of course, hyperfibrinolysis, and thus the indication for tranexamic acid administration, can also be detected in ROTEM.