Клінічна сонореометрія: Інноваційне рішення для контролю масивних кровотеч

Едгар Ламазян, провідний фахівець напрямку діагностики станів та порушень системи гемостазу, ТОВ "Медична Техніка"

1. InnoBalliline pimeHHA AA
KO p OKO MACHBHHX KPOBOTE4

Quantra® Hemostasis System

B cepueBo-cyanxHiñ xipyprii,
TPABMATOOT I, OPTONEJI, AKYIHEPCTBI Ta
TIPA TPAHCILIAHTALIAX

Janazan E.P., nposidnuit paxiceue nanpamy diaznocmuxu cmanis ma nopyueno cucmemu
eemocma3y, TOB «Meouuna Texnixa»

2. Baxk1MBicTh MEHEXKMEHTY KOMIIOHEHTIB KpoBi

Y 2021 poni Beecnirna opranizania oxoponn 310p08'x (BOO3)
BUNyCTHIA AHATITHANY 3AMHCKY NPO HATAJIBHY NOTPEOY
BUpORALKCHHsA MeHeLKMeHTY Kpopi manienta y 192 kpainax-
yıenax!

Menexxmenr xpopi nanichra (MKTI) - ue opicrropannii na manicura,
clicTeMaTHuHuti, 10Kasopul MXN, CHPAMOBAHHI Ha NOKPAILEHHA
pesyastarip sikypaniia nuinom ynpabzimna Ta 36epexenkis BJACHOÏ
Kpopi nanich

Tlinsnmenns pisna Incbexuii uentpamphoi
Tepemupanna 3aXBOPIOBAHOCTÍ TA CMEPTHOCTÉ nenn
Kposi nog'a3ane 3 Jlereneni ra ceprepi Tprpaniumi repmix
peGaxanumu yernannenna nepeöynanıs na zixynanı
ae) ; 36inemens
Hacaizıkamn Inexuit xipypriunoi zonn

Hikapnanıx BHTPAT

Su

POLICY BRIEF

Surgical Outcomes and Transfusion
Amounts of Blood in the Opera

ing Room

0 12 34 56 78 91011121314 215
RBCS, Units
= Mortalty — m Composite Morbidity

packed red blood cells (PRBCS) received in intraoperative blood tra

$

3. Henonikn Tpaquuiitnux MeToziB TpomOoenactorpadii

Mac OTPHMAHHA Pe3yJIbTa" Cki1a1Homi y KOPHCTyBaHHi Cxkuaaanicro ixrepnperauii

= Tipu rocrpiit xposoresi aikapi nosuani = Tlorpiöne pyune ninerysanna * Inrepnperania cxaaanux rpapixis
LIBHAKO mpuiimarn pimenns Ta ist = Uacruii xourpoap akocri umarac snaunof KÉIBKOCTI
= Yepes rexnisni o6mexenns, JAMOBACHNA O de Tpenynans Aaa niatpumanns

LABO

HHX KOMTIOHCHTIB KpoBi 3aliMac xorrponto axocri, VET uacro
vac MPOBOAMTECA B slaGoparopii, mo
= Tas orpunanns neix pesyasrario VET aux 3YMOBIOC 3ÓLIBHICHHA Hacy

omnia Pusukin u

¡orpióno 40-60 orpumanns pesyns

B nocHinpKenn.

4. Conopeomerp Quantra® - InnoBauiäne pimenusa B 061acrTi
BICKOEJIACTOMETpÜ Bi, komnanii Hemosonics (CHIA)

tra = B ocuosi podorn anasıizaropa QUANTRA sexuTh yaprpassykope
& uantra oninonasinst enacraunoel Srycray¡3a Meronom pesouancuol

Hemostasis Analyzer E ® =
conopeomerpii (SEER) ~ 3anaremtopanoi TexHoxoril, aKa
BHKOPHCTOBY€ VIBTPA3BYK JUIA BUMIpIOBAHHA 3MIH B'A3KOCIACTHUHHX
BIIACTHBOCTEH HiJIBHOÏ KpoBi B MPONECÍ 3TOPTAHHA.

Conopeomerpia SEER nependauae nancnsanna cepii
yabrpasBykOBHX iMnysbciB 10 3pa3ka misbnol kpoBi, Io MicTHTECA B
Kapıpiupki, Ta O6poOKy 3BOPOTHHX exO-curHaiB, Ha OCHOBI AKHX i
3nilicmoerbch BHMÍPIOBAHHA MiLHOCTI 3rycTKY B 3PA3KY KpoBi B
npoueci sropranus.

5. Quantra® poOnTb B'I3KOCHACTHYHE TecTyBaHHa HIBM/IKMM, IPOCTUM ra
HAJUHHHM

Tlepıni pesynsraru CT 3a 5 xpusmun, a peurra pesynsraris OpicHTOBRO.
3a 12,5 xenmn!
| Ilpocrora intepnperauii pesyabraris: Jlerknÿ 219 intepnperauii

uantra HIBM]KI pesyasrarn: 3a6e3nenye nanilni ra xieni pesysrarn.
a |

Aancnneii ımdep6narig 214 mBm1koro amasisy NOTEHLIHHOÏ

koaryaonari?

HAJUHI pesyaprarn: 3a paxynox HoBoï 3arareToBanoï
yarpa3Bykonoi Texmonori

Hañumpuii noxazamna cepea naargopm VET na ocuosi kaprpunaie:
aprioxipypris ra oprorienmuna xipypria

= QStat® Cartridge: Tpasma & Tpanenanrania neuinkn

1 TIpnsnauennü ANA BHKOPHCTAHHA B MICUAX HAAAHHA MEAHUHOÏ
aonomoru (Point of care) Ta B 1a6oparopi

6. Hocnimkenna Ha Quantra® npOBOAATBCA 3 BHKOPHCTAHHAM BOX

THNÏB KAPTPHAXKIB

eee

Hanac upariani aani as Menexxmenty aikypannsn:
CeKCAMOBOIO KHCIIOTO1O, TPOMÖOHHTAMH, KOHILEHTPATOM
spionpenunirary/iöpnmoreny Ta cBixosamopoxenoro
naasmoïo (FFP) a60 KonneirrparoMm mporpomGintonoro
Komnaekey (PCC)

QPlus® kaprpnux AIS cepueño-cyammnoli xipyprii

= Hanac npaxtuuni jani aa Menewkmenty aixypanns:

nporaminom, tpomGounramn, KOHLEHTPATOM
Kpionpemmirary/biGpnnoreny Ta crixozamopoxenoro

n.1a3m010 (FFP) ao Konnentparom nporpom0inonoro

kommaexey (PCC)

7. Cepuepo-eyanıma xipyprist
Tlapametpu Kaprpuaxxy Quantra QPlus® 103B0.1910Tb IUBHAKO
BHABJIATH ACQÍLMTH 3 TIONAJIBIUHMH TepaneBTH4HHMH PeKOMeH anima

BuaBaac noumpeni koaryaonarii 8 kapaioxipypril
CS (Clot Stiffness): Moxe csiquutu mpo 3aranbunii rino- ado
rinepxoarysmiiinuit cran
FCS (Fibrinogen contribution to CS): Moxe cxixaurn npo xeiuur
i6pmmoreny np amen
PCS (Platelet contribution to CS) moxe enixunrn npo nedinnr
Kitbkocti Ta/a60 NOpyMeHEApykuii TpoMOounTiB pa 3HHKeHHI

CT (Clotting Time) lloxomxenti sHaeHHA MORYTB CBIASHTH TPO SHHACHHA yTROpeHHA TPOMÖIRY Yepes HIER
depmenrarupni paxropn a60 Aito aHTHKOATYAAHTHOTO nperrapary

CTH (CT with Heparinase) lloxoxenni 3Hauenna MOXYTB CRLIUHTH TIPO 3HIDKEHE yrBOpeHHA TpoMOiny Yepes HHBbKi
depmenrarupni paxropn a60 BILIHB ANTHKOATVAAHTHOTO npenapary, BÜIMIHHOTO Bi TENAPHRY

CTR (Clot Time Ratio) Cnissimomenus CT ra CTH; curnanisye npo 3ammukosnii renapun, Kom pisens nepesmutye 1,4

8. Quantra® BuKOHYE B'13koeJtacrT
ra HAJIIMHO (BE3I1

QPlus® ocHoBHi WKAJIH AMCHTCIO

The QPlus® kaprpiyox nanae kopnchy inopmanix
JU BUSHAYEHHA TAKTHKH JTIKYBAHHA 3a AOMOMOTOK
nporaMiny, Tpomountis,
kpionpeunnitaty/idpunoreny, cBixo3amopoe
HIASMH/KOHUCHTPATY MPOTpomGinOBOro
KommueKcy

Y xoui HaBdaHHA HOBHX KOPHCTYBauiB, Bake mica 3
XBHJHHHOTO Tpeninry MOXYTB UNTATH Ta
intepnpetyparn peayarsrarm, mo BiLOGparKa‘OT!

undepönarax Quantra®, 3 edbexrupiticrio 95%!

9. ‘Tpancnaantanis nesinku ra Tpapma

Tlapametpu Kaprpaxxy Quantra 3a0e3reuye IIBHAIKE BMABJICHHA
nebinmTig 13 HOHANDIIHMH TEPANCBTHAHAMH PEKOMEHJALIAMA

Bnabase noumpeni koaryaonarii npn Tpa
euiHKH:

CSL (Clot Stability to Lysis) Moxe BKa3yBaTH na nopymenna
iGpunosisy (rinep- año rino- piGponiz)

CS (Clot Stiffness) Moxe Bkaaysarıı na 3aranbunii rino- ado
rinepkoaryamidinud cran 3rycTky

Ta Tpanenaanranii

a

(Fibrinogen contribution to E Ka3ÿBATH Ha Jedi piopHnoreny
PCS (Platelet contribution to CS) [pu snwxenni Moxke BKa3ÿBaTH Ha xeqimr KisbKOCTi TpoMGonmriB ra/a60
nopymemna ix @ynKuii
CT (Clotting Time) [pu nonopxenni Moxe BKa3YBATH Ha 3HHKCHE yTBOpeHHA TPOMÖINy Yepe3 HH3BKHÏ piBeHD
Depuerrrunx pakropis a60 BILIMB AHTHKOATYIAHTHOTO nperapaTy

10. Quantra® BuKOHYE BicKoenacTH
HAJIIMHO

QStat® ocHoBHi kan AMCHNJICIO

= Kaprpujox QStat® Haxac kopucni Jani IA
BUABJCHHA HAABHOCTÍ JI3HCY TPOMÖy Ta
enpamyBanna JIKYBAHHA TPAHEKCAMOBOIO
KHC10TOIO, TPOMÓOINTAN
Kpionpeuunirarom/piGpanorenom Ta
CBiKO3AMOPOXKEHOIO MITAZMOJO/
POTPoMÖINOBOTO KOMNE!

= Tlicaa 30-XBIIMHROTO HABAAHRA Hopi KOPHCTYBaui
SUHTYIOTS Ta IHTEPTIPETYIOTB PEVIBTATH
undep6narip Quantra® 3 95% malicrepnicrio!.

fest 26.0023

11. Quantra® po6HTB BI3KOCHACTHYHE Te anna LIBAU KUM, HPOCTUM
ra HAJIMHUM

TepHaTuBanii intepdeiic 3 rpaqixamn Inrepbeic Tpenais

cr 0105
CSL 057%

CS. 21.01
PCS 19.010»
FCS 201

= Tlepemuxaiiteca mix unhepGnaramn Ta eniuxylite sa KPHBHMH, 1106

TH posbHToK CS Ta CSL, 1 3a OCTAHH

» Kinueni pesyasraru Tecry BitoGpaxkaiorses npanopy4. 1 = KoHTposIbH 2

12. VHikaJIbHHú MapaMeTp — HPAMOTO
KOpcTkicTb 3ryctky (PCS)

Ilepesara npaMoro sumipiopanın
[rn]

= Quantra® - ne ex VET inerpyment, ski
npononye ya napamerp Be
‘TpomGommtis (PCS), aknit pmwiproc komGinosamit
Britis kimbrocri TpomÓomrrib Ta ix
y

xao

moctil

fc Toune npame BuMipiorantn, uO
ac Becox TpoMGourie y exacruunicra

aryeray

= Quantra® naitrounime npornosye niensonepaniliiy
xponoresy niens CPB nopipnano 3 inma VET Ta

ecran TpomGomurTip®

* Quantra® 3aesnesr
npornoc:

BHCOKe Herarmbne
1x us TpoGounronen Ir

une anauel

BH3HAYCHHSI BHCCKY TPOMOOLHTIB y

mm
Are Viscoelastic Tests Clinically Useful to Identify
Platelet Dependent Bleeding in HighRisk Cardiac
‘Surgery Patients?

Ouiuxa npormocruunol auauywocr sinbnoerl ra dyuxuj TpoMBounie nienn ustyunoro
kposooGiry (CPB) npu nporkoaysanhi macusnol kposoresi

mE Auca co VI Cneumbinie PPV (5%

ra nee eh
AA)
Platelet cout
077055098) 001 one 15 MG | ELE) HU
(o100/ut) h d || THERES) | 5188228
PO a rs(ost0os) om om a EURE MEL) 520876)
ROTEM Pc(mm) 074(050090) mm ow a Muse HU) Gr
MERDE 067(042091) os M 2 GG) sr) 80157)
MeATHAPtet(U) 032107080) 389 1000 MAL SGL6) 2320067

py. Ann ny 20512160 87
carer tr Ann An 3021391101200

$

13. I py nanienTiB, IKHM PEKOMEH]IOBAHO MPOBEACHHA
COHOPEOMETPHYHHX Joc KeHb QUANTRA:
- HALIEHTH 3 MACHBHAMH KPOBOTEYAMH

- HAHICHTH TPYIIH BHCOKOTO TEMOPPATIYHOTO 10

14. HPHKJIAN AOCILTKEHHA TAIICEHTA 3 MACHBHUMU
KPOBOTEYAMH

(CT + CS) — PCS — FCS ze,ıena 30Ha
npuunum

Kposoresa sepes remocra: Kposoresa 3 xipypriunoï npuunnn

15. HPHKJIAN AOCJILTKEHHA HAHIEHTA 3 MACHBHOIO
KPOBOTEYAMH

TPAHC®Y3ISI HE IIOTPIBHA TPAHC®Y3IA HOTPIBHA
Cuerema 3roprannn B HopMi Hanna Kposoreua

16. 2KEHHA TWAQIEHTA _TPYIIH BUC

17. HPHKJIAA JOCIUDKEHHA HANIEHTA TPYIINH BHCOKOTO
TEMOPPATIYHOTO PH3HKY

ICT + CC PORRO

18. Anropa TM JIHKYBAHHA 13 3ACTOCYBAHHAM QUANTRAO npa Tpabmi

me enocrepexenun/alarnos

Tax

Huspxuii DiGpunoren
FCS < 1,0 hPa (~ 1,5g/L) Piöpnnorenopnä Konnentpar a00

FCS < 1,6 hPa (- 2.0; ckopuctaiitech TadmusIMH 103YBAHE **

Tepeampanus rpomÖonuris:
PCS< 11.8 hPa= Loja
PCS < 8.0 hPa = 2 opi

dbynikuionannicrs
PCS <11,8 hPa (~ 150

G/L) PCS<8 hPa (~ 75

GIL} Fae

Tepesmmannia cniaosanopoaseniot nutasyn/conmterpara,
POMO MALICE:

Mac renepyBanHx TpoMGiny noJomxer

Opicnronno 30 mL kg
Posranuere mescrunicre npaxomeuua Es mo CSL < HEMOSONICS

19. ANTOPHTM MepesMBaHHA KOMIIOHEHTIB KpoBi 13 3aCTOCYBAHHAM QUANTRA, skuii
Ci] BAKOpUCTOByBaTH JIMILE Y pa3i KPOBOTEUI

Mepexymosn:
-Temp > 35.5 C
-pH > 7.30
-Ca?* > 1 mmol/L FCS < 1.0 hPa —Is—| Fg 25-50 mg/kg
-Hb > 8 g/ dL (Except sickle cell disease) IL
-Cell salvage except contra-indicated No
-Tranexamic acid Ih bolus+ 1g/8h +
-In case of bleeding QUANTRA test and PCS < 5.4 hPa Plt 0.7x1011/10 kg
transfusion according to algorithm |
No
err FFP 2 15ml/kg
E
No
y
CSL < 90% YES Tranexamic acid 1g

(Mpobecop HOnitoc Mramexac) 6 HEMOSONICS

20. Quantra
Uleudko, IIpocmo, Hadiúno! |

AK YIO!