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<article article-type="research-article" dtd-version="1.3" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xml:lang="ru"><front><journal-meta><journal-id journal-id-type="publisher-id">bloodjour</journal-id><journal-title-group><journal-title xml:lang="ru">Гематология и трансфузиология</journal-title><trans-title-group xml:lang="en"><trans-title>Russian journal of hematology and transfusiology</trans-title></trans-title-group></journal-title-group><issn pub-type="ppub">0234-5730</issn><issn pub-type="epub">2411-3042</issn><publisher><publisher-name>ООО Издательский дом «Практика»</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.35754/0234-5730-2023-68-2-241-270</article-id><article-id custom-type="elpub" pub-id-type="custom">bloodjour-459</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="ru"><subject>ОБЗОРЫ ЛИТЕРАТУРЫ</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="en"><subject>REVIEWS OF LITERATURE</subject></subj-group></article-categories><title-group><article-title>Роль научно-обоснованных алгоритмов ротационной тромбоэластометрии для лечения кровотечений</article-title><trans-title-group xml:lang="en"><trans-title>The role of evidence-based algorithms for rotational thromboelastometry-guided bleeding management</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-7315-9528</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Герлингер</surname><given-names>К.</given-names></name><name name-style="western" xml:lang="en"><surname>Görlinger</surname><given-names>K.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Клаус Герлингер, доктор медицины</p><p>Отделение анестезиологии и интенсивной терапии</p><p>Кафедра анестезиологии и интенсивной терапии</p><p>Эссен; Мюнхен</p></bio><bio xml:lang="en"><p>Klaus Görlinger, MD</p><p>Department of Anesthesiology and Intensive Care Medicine</p><p>Essen; Munich</p></bio><email xlink:type="simple">kgoerlinger@ilww.com</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-0913-4446</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Перес-Феррер</surname><given-names>А.</given-names></name><name name-style="western" xml:lang="en"><surname>Pérez-Ferrer</surname><given-names>A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Антонио Перес-Феррер</p><p>Отделение анестезиологии</p><p>Сан-Себастьян-де-лос-Рейес, Мадрид</p></bio><bio xml:lang="en"><p>Antonio Pérez-Ferrer</p><p>Department of Anesthesiology</p><p>San Sebastián de los Reyes, Madrid</p></bio><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-0118-1889</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Диркманн</surname><given-names>Д.</given-names></name><name name-style="western" xml:lang="en"><surname>Dirkmann</surname><given-names>D.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Даниэль Диркманн</p><p>Отделение анестезиологии и интенсивной терапии</p><p>Эссен</p></bio><bio xml:lang="en"><p>Daniel Dirkmann</p><p>Department of Anesthesiology and Intensive Care Medicine</p><p>Essen</p></bio><xref ref-type="aff" rid="aff-3"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-9157-4573</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Санер</surname><given-names>Ф.</given-names></name><name name-style="western" xml:lang="en"><surname>Saner</surname><given-names>F.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Фуат Санер</p><p>Отделение общей, висцеральной и трансплантационной хирургии</p><p>Эссен</p></bio><bio xml:lang="en"><p>Fuat Saner</p><p>Department of General, Visceral and Transplant Surgery</p><p>Essen</p></bio><xref ref-type="aff" rid="aff-4"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-0634-4723</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Маегеле</surname><given-names>M.</given-names></name><name name-style="western" xml:lang="en"><surname>Maegele</surname><given-names>M.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Марк Маегеле</p><p>Отделение травматологии и ортопедической хирургии</p><p>кампус Кельн-Мерхайм, Кельн</p></bio><bio xml:lang="en"><p>Marc Maegele</p><p>Department for Trauma and Orthopedic Surgery</p><p>Cologne</p></bio><xref ref-type="aff" rid="aff-5"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-1691-0730</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Калатаюд</surname><given-names>А.А. П.</given-names></name><name name-style="western" xml:lang="en"><surname>Calatayud</surname><given-names>A. A. P.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Анхель Аугусто Перес Калатаюд</p><p>Terapia Intensiva Adultos</p><p>координатор Мексиканской группы по вопросам интенсивной терапии</p><p>Керетарко</p></bio><bio xml:lang="en"><p>Angelo Augusto Pérez Calatayud</p><p>Terapia Intensiva Adultos</p><p>Coordinador Grupo Mexicano para el Estudio de la Medicina Intensiva</p><p>Queretarco</p></bio><xref ref-type="aff" rid="aff-6"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-0806-8969</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Ким</surname><given-names>Т. Й.</given-names></name><name name-style="western" xml:lang="en"><surname>Kim</surname><given-names>T.-Y.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Тхэ Йоп Ким</p><p>Кафедра анестезиологии</p><p>Медицинский центр Университета Конкук</p><p>Сеул</p></bio><bio xml:lang="en"><p>Tae-Yop Kim</p><p>Department of Anesthesiology</p><p>Konkuk University Medical Center</p><p>Seoul</p></bio><xref ref-type="aff" rid="aff-7"/></contrib></contrib-group><aff-alternatives id="aff-1"><aff xml:lang="ru"><institution>Университетская клиника Эссена, Университет Дуйсбург-Эссен; Tem Innovations</institution><country>Германия</country></aff><aff xml:lang="en"><institution>University Hospital Essen, University Duisburg-Essen; Tem Innovations</institution><country>Germany</country></aff></aff-alternatives><aff-alternatives id="aff-2"><aff xml:lang="ru"><institution>Университетская клиника Инфанты Софии</institution><country>Испания</country></aff><aff xml:lang="en"><institution>Infanta Sofia University Hospital</institution><country>Spain</country></aff></aff-alternatives><aff-alternatives id="aff-3"><aff xml:lang="ru"><institution>Университетская клиника Эссена, Университет Дуйсбург-Эссен</institution><country>Германия</country></aff><aff xml:lang="en"><institution>University Hospital Essen, University Duisburg-Essen</institution><country>Germany</country></aff></aff-alternatives><aff-alternatives id="aff-4"><aff xml:lang="ru"><institution>Университетская клиника Эссена, университет Дуйсбург-Эссен</institution><country>Германия</country></aff><aff xml:lang="en"><institution>University Hospital Essen, University Duisburg-Essen</institution><country>Germany</country></aff></aff-alternatives><aff-alternatives id="aff-5"><aff xml:lang="ru"><institution>Кельн-Мерхаймский медицинский центр (CMMC); Институт исследований в области оперативной медицины (IFOM), Университет Виттена/Гердекке (UW/H)</institution><country>Германия</country></aff><aff xml:lang="en"><institution>Cologne Merheim Medical Center (CMMC); Institute for Research in Operative Medicine (IFOM), University Witten/Herdecke (UW/H)</institution><country>Germany</country></aff></aff-alternatives><aff-alternatives id="aff-6"><aff xml:lang="ru"><institution>Больница специальных исследований Ниньо и Мюджера; Мексиканская коллегия врачей-специалистов по критическому акушерству (COMEOC)</institution><country>Мексика</country></aff><aff xml:lang="en"><institution>Hospital de Especialidades del Niño y la Mujer; Colegio Mexicano de Especialistas en Obstetrica Critica (COMEOC)</institution><country>Mexico</country></aff></aff-alternatives><aff-alternatives id="aff-7"><aff xml:lang="ru"><institution>Школа медицины Университета Конкук</institution><country>Южная Корея</country></aff><aff xml:lang="en"><institution>Konkuk University School of Medicine</institution><country>Korea, Republic of</country></aff></aff-alternatives><pub-date pub-type="collection"><year>2023</year></pub-date><pub-date pub-type="epub"><day>20</day><month>07</month><year>2023</year></pub-date><volume>68</volume><issue>2</issue><fpage>241</fpage><lpage>270</lpage><permissions><copyright-statement>Copyright &amp;#x00A9; Герлингер К., Перес-Феррер А., Диркманн Д., Санер Ф., Маегеле M., Калатаюд А.П., Ким Т.Й., 2023</copyright-statement><copyright-year>2023</copyright-year><copyright-holder xml:lang="ru">Герлингер К., Перес-Феррер А., Диркманн Д., Санер Ф., Маегеле M., Калатаюд А.П., Ким Т.Й.</copyright-holder><copyright-holder xml:lang="en">Görlinger K., Pérez-Ferrer A., Dirkmann D., Saner F., Maegele M., Calatayud A.P., Kim T.</copyright-holder><license xml:lang="ru" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>Данная работа распространяется под лицензией Creative Commons Attribution 4.0.</license-p></license><license xml:lang="en" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>This work is licensed under a Creative Commons Attribution 4.0 License.</license-p></license></permissions><self-uri xlink:href="https://www.htjournal.ru/jour/article/view/459">https://www.htjournal.ru/jour/article/view/459</self-uri><abstract><p>Ротационная тромбоэластометрия (РОТЭМ) является методом диагностики, «выполняемым по месту лечения» (pointof-сare), который позволяет оценить вискоэластические свойства цельной крови в различных клинических условиях. Лечение острой кровопотери, проводимое под контролем РОТЭМ, стало неотъемлемой частью концепции, именуемой «Менеджмент крови пациента» (МКП), целью которой является повышение безопасности лечения больных с кровотечениями. В этом случае диагностика, выполняемая с помощью РОТЭМ, и проводимая на ее основе гемостатическая терапия должны быть связаны между собой научно обоснованными специфическими алгоритмами, адаптированными к конкретной группе больных в медицинских стационарах, и к возможности применения интервенций в области гемостаза, доступных в том или ином учреждении. Соответственно, алгоритмы диагностики, основанные на данных РОТЭМ, реализуют концепцию персонализированного или прецизионного лечения кровотечений в периоперационном периоде или «тераностический подход», т. е. сочетание персонализированной диагностики и целенаправленного лечения. Как было показано раннее, концепция МКП, основанная на данных РОТЭМ, позволяет эффективно уменьшить объем кровопотери, потребности в трансфузиях, количество осложнений и стоимость лечения. В рандомизированных контролируемых исследованиях, метаанализах и оценках медицинских технологий показано, что использование алгоритмов РОТЭМ привело к повышению безопасности больных и улучшению результатов лечения, включая уменьшение периоперационной заболеваемости и смертности. Однако имплементация РОТЭМ в концепцию МКП требует, чтобы пользователи имели адекватную техническую подготовку, были обучены интерпретации результатов, логистике, а также осуществлялись междисциплинарная коммуникация и сотрудничество врачей.</p></abstract><trans-abstract xml:lang="en"><p>Rotational thromboelastometry (ROTEM) is a point-of-care viscoelastic method and enables to assess viscoelastic profiles of whole blood in various clinical settings. ROTEM-guided bleeding management has become an essential part of patient blood management (PBM) which is an important concept in improving patient safety. Here, ROTEM testing and hemostatic interventions should be linked by evidence-based, setting-specific algorithms adapted to the specific patient population of the hospitals and the local availability of hemostatic interventions. Accordingly, ROTEM-guided algorithms implement the concept of personalized or precision medicine in perioperative bleeding management (“theranostic” approach). ROTEM-guided PBM has been shown to be effective in reducing bleeding, transfusion requirements, complication rates, and health care costs. Accordingly, several randomized-controlled trials, meta-analyses, and health technology assessments provided evidence that using ROTEM-guided algorithms in bleeding patients resulted in improved patient’s safety and outcomes including perioperative morbidity and mortality. However, the implementation of ROTEM in the PBM concept requires adequate technical and interpretation training, education and logistics, as well as interdisciplinary communication and collaboration.</p></trans-abstract><kwd-group xml:lang="ru"><kwd>алгоритмы</kwd><kwd>лечение кровотечений</kwd><kwd>расходы на здравоохранение</kwd><kwd>импедансная агрегометрия</kwd><kwd>менеджмент крови пациента</kwd><kwd>тромбоэластометрия</kwd></kwd-group><kwd-group xml:lang="en"><kwd>algorithms</kwd><kwd>bleeding management</kwd><kwd>health care costs</kwd><kwd>impedance aggregometry</kwd><kwd>patient blood management</kwd><kwd>thromboelastometry</kwd></kwd-group></article-meta></front><back><ref-list><title>References</title><ref id="cit1"><label>1</label><citation-alternatives><mixed-citation xml:lang="ru">Zacharowski K., Spahn D.R. Patient blood management equals patient safety. Best Pract Res Clin Anaesthesiol. 2016; 30(2): 159–69. 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