"This is translational research at its pinnacle in terms of saving lives," says Castellino, Keck Center director. "I've been in the business of all aspects of blood clotting for 40 years. Finally, to get to a point where you're applying this to patient care is something we've built over a 40-year period." Listen
Memorial physicians are among the first to be using the TEG analyzer in the ER to determine the best strategy to stop a patient's extreme blood loss through the formation of stable clots.
"The [traditional] tests that we have to determine if a patient can clot well only test a portion of the blood," says Memorial Trauma Physician Dr. Mark Walsh. "[The TEG analyzer] involves all the components of making a clot." Listen
Prior to using the TEG analyzer, Walsh's team looked only at the patient's plasma to determine the best strategy to stop bleeding.
"Just looking at the plasma of the patient, which is typical, you know the rate of clotting of plasma proteins," says Castellino, "but that doesn't take the cellular components into account."
Walsh likens a successful blood clot to a bag of marbles; the marbles represent the cellular components—red cells and platelets. Glue holding the marbles together represents plasma, and the bag is the fibrin of a clot. In the past, Walsh says his team only measured and paid attention to the "glue" in the bag.
"You need every component—the marbles, the glue, the bag—to make a clot. Instead of measuring just the glue, we measure all three components [with the TEG analyzer]," says Walsh. "When you need to give people a lot of blood products, you can't just throw the marbles at the people, or just the glue. You need to balance the way you give the red cells and platelets, plasma and fibrin—the marbles, glue and bag. You need to give it in a goal-directed fashion; goal-directed blood component therapy is a new concept."
Walsh says previously used blood tests aren't capable of measuring all three components and would require too much time for a trauma patient. However, the TEG analyzer gives doctors the multiple measurements in 11 to 30 minutes. Listen
"With the TEG, you can give blood products to them early and in the proper ratios such that they'll have much better outcomes than if you don't use it," says Walsh. "If you don't give blood factors in the proper ratio, you run the risk of causing a huge lack of equilibrium in the patient's blood, and the patient will die." Listen
Walsh says this "delicate dance" of giving the right blood products at the right time has saved the lives of trauma patients at Memorial. The partnership between basic science researchers and physicians is thrilling for Castellino, helping his research come to life.
"The basic satisfaction is you're contributing to the saving of lives, which is one of Notre Dame's missions," says Castellino.
Walsh estimates the hospital has used the new tool on about 150 patients, often car accident or gunshot victims; he says the team's success is garnering much attention.
"We have these famous institutions approaching us to collaborate," says Walsh. "That's very gratifying, and it's uncommon and unchartered territory. It's an example that when you're the tip of the spear of science, it doesn't matter where you are."
Castellino believes continuing his research will lead to the TEG analyzer being widely used in trauma medicine—saving more lives with experts in South Bend leading the way.