ROTEM Analyzer
Algorithm-Driven Decision Support
Algorithm and thresholds change with context. The four primary contexts use the published Görlinger A5 algorithms verbatim.
Coagulation enzymes fail when these are uncorrected — algorithms assume they are corrected first.
Per Trauma A5 algorithm, these define when ROTEM-guided therapy and TXA are triggered on ER admission.
PPH A5 algorithm triggers: vaginal > 500 mL · cesarean > 1000 mL · severe > 1500 mL.
Liver A5 algorithm uses different fibrinolysis cutoffs by phase: LI60_EX < 85% (preanhepatic) vs LI30_EX < 50% (anhepatic/reperfusion).
Cardiovascular A5 algorithm step 2 uses ACT_after_protamine vs ACT_baseline + CT_IN/CT_HEP ≥ 1.25.
On ECMO, INTEM/HEPTEM ratio ≥ 1.25 is the THERAPEUTIC TARGET. Reverse only with active bleeding.
Phase determines therapy: hypercoagulable (microthrombi) vs hypocoagulable (bleeding). Treat the cause first.
TRAPTEM/ADPTEM — used in Trauma and Cardiac A5 algorithms to detect platelet dysfunction.
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ROTEM screen
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