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The use of fibrinogen concentrate for the management of trauma-related bleeding: a systematic review and meta-analysis. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2018; 15:318-324. [PMID: 28661856 DOI: 10.2450/2017.0094-17] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Accepted: 04/11/2017] [Indexed: 12/25/2022]
Abstract
Haemorrhage following injury is associated with significant morbidity and mortality. The role of fibrinogen concentrate in trauma-induced coagulopathy has been the object of intense research in the last 10 years and has been systematically analysed in this review. A systematic search of the literature identified six retrospective studies and one prospective one, involving 1,650 trauma patients. There were no randomised trials. Meta-analysis showed that fibrinogen concentrate has no effect on overall mortality (risk ratio: 1.07, 95% confidence interval: 0.83-1.38). Although the meta-analytic pooling of the current literature evidence suggests no beneficial effect of fibrinogen concentrate in the setting of severe trauma, the quality of data retrieved was poor and the final results of ongoing randomised trials will help to further elucidate the role of fibrinogen concentrate in traumatic bleeding.
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Lubnin AY. [The use of activated recombinant factor VII in neurosurgery]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2018; 82:112-119. [PMID: 29795095 DOI: 10.17116/oftalma2018822112-119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- A Yu Lubnin
- Burdenko Neurosurgical institute, 4-ya Tverskaya-Yamskaya str., 16, Moscow, Russia, 125047
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Guo J, Tian G, Zhao Q, Jiang T. Fast hemostasis: a win-win strategy for ultrasound and microwave ablation. Onco Targets Ther 2018; 11:1395-1402. [PMID: 29559797 PMCID: PMC5856047 DOI: 10.2147/ott.s151219] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Hemorrhage is a serious complication following percutaneous biopsy requiring detecting and immediate treatment of active bleeding. This study aimed to explore the potential benefits of ultrasound (US)-guided microwave ablation (MWA) to treat acute hemorrhage in risky locations. Materials and methods We present seven patients (four males and three females) aged 19–69 years with solid-organ arterial hemorrhage treated by US-guided MWA and followed up with contrast-enhanced US (CEUS). Results All seven cases successfully underwent MWA for hemostasis, and their vital signs subsequently stabilized. During the follow-up from 13 to 36 days, the ablation area decreased slowly in five patients and was still stable in two cases. There were no complications observed in this study after MWA treatment. We also reviewed a total of 12 publications in the past 10 years. Conclusion This study suggested that US-guided MWA may be an effective and safe strategy for acute hemorrhage in the emergency setting. To confirm this method and benefit more patients, more prospective studies with larger samples and longer follow-ups are recommended.
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Affiliation(s)
- Jiabao Guo
- Department of Ultrasound Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Guo Tian
- Department of Ultrasound Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, Hangzhou, China
| | - Qiyu Zhao
- Department of Ultrasound Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Tian'an Jiang
- Department of Ultrasound Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, Hangzhou, China
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Tang JH, Lyu Y, Cheng LM, Li YC, Gou DM. Risk Factors for the Postoperative Transfusion of Allogeneic Blood in Orthopedics Patients With Intraoperative Blood Salvage: A Retrospective Cohort Study. Medicine (Baltimore) 2016; 95:e2866. [PMID: 26937919 PMCID: PMC4779016 DOI: 10.1097/md.0000000000002866] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 01/23/2016] [Accepted: 01/27/2016] [Indexed: 11/25/2022] Open
Abstract
The purpose of this study is to explore the risk factors affecting the postoperative transfusion of allogeneic blood in patients undergoing orthopedics surgery with intraoperative blood salvage (IBS). A retrospective study of 279 patients undergoing orthopedic surgeries with IBS from May 2013 to May 2015 was enrolled. The binary logistic regression was used to find out the risk factors associated with postoperative transfusion of allogeneic blood in orthopedics patients with IBS, and then receiver operating characteristic (ROC) curve was drawn to determine the optimal threshold of the regression model.Single factor analysis showed that age, American Society of Anesthesiologists (ASA) grade, preoperative hemoglobin, operation time, received autologous blood, the laying time of autologous blood, bleeding volume, and postoperative drainage volume had significant effects on postoperative allogeneic blood transfusion.In binary logistic regression analysis, the independent factors predicting orthopedic patients with IBS need to transfuse allogeneic blood after surgeries were age (odds ratio [OR] = 0.415, P = 0.006), ASA grade (OR = 2.393, P = 0.035), preoperative hemoglobin (OR = 0.532, P = 0.022), and postoperative drainage volume (OR = 4.279, P = 0.000). The area under ROC curve was 0.79 and the predicted accuracy rate of the model was 81.58%.After operation, the orthopedic patients with IBS still have a high allogeneic blood transfusion rate, and IBS is not a perfect blood protection method. The logistic regression model of our study provides a reliable prediction for postoperative transfusion of allogeneic blood in orthopedic patients with IBS, which have a certain reference value.
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Affiliation(s)
- Jia-Hua Tang
- From the Department of Anesthesiology, Zunyi Medical University, Zunyi, Guizhou, China (J-HT, D-MG); Department of Anesthesiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China (YL, Y-CL); and Department of Anesthesiology, Kunming Children's Hospital, Kunming, China (L-MC, YL)
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Zhou L, Kuang M, Xu Z, Xie X, Lu M. Contrast-enhanced sonographically guided thermal ablation for treatment of solid-organ hemorrhage: preliminary clinical results. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2015; 34:907-915. [PMID: 25911724 DOI: 10.7863/ultra.34.5.907] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The purpose of this series was to preliminarily evaluate the use of contrast-enhanced sonographically guided percutaneous thermal ablation in the evaluation and treatment of solid-organ bleeding by retrospectively analyzing 6 cases observed in clinical practice. Six patients who underwent contrast-enhanced sonographically guided thermal ablation for treatment of solid-organ bleeding (5 in liver and 1 in spleen) from December 2005 to August 2012 were included in this series. Clinical information, contrast-enhanced sonograms before and after ablation, and the ablation method were retrospectively collected and analyzed. In 5 of the 6 patients, the location of the bleeding lesion was clearly seen. Hemostasis was successfully achieved in 4 of these 5 patients: 1 by radiofrequency ablation and 3 by microwave ablation. Ablation failed to achieve hemostasis in 1 patient who had postbiopsy splenic arterial bleeding because the bleeding vessel was a thick branch of the splenic artery. In the sixth remaining patient, who had bleeding after liver biopsy, hemostasis failed because contrast-enhanced sonography did not precisely locate the bleeding lesion; hence, the ablation zone did not cover the whole lesion. Contrast-enhanced sonographically guided ablation can be an alternative choice for treating solid-organ bleeding because of its effectiveness and minimal invasiveness. However, it should be carefully investigated for those in whom the bleeding lesion cannot be located by contrast-enhanced sonography and in those who have bleeding in a large vessel.
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Affiliation(s)
- Luyao Zhou
- Department of Medical Ultrasonics, Institute for Diagnostic and Interventional Ultrasound (L.Z., Z.X., X.X.), and Department of Hepatobiliary Surgery (M.K., M.L.), First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Ming Kuang
- Department of Medical Ultrasonics, Institute for Diagnostic and Interventional Ultrasound (L.Z., Z.X., X.X.), and Department of Hepatobiliary Surgery (M.K., M.L.), First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Zuofeng Xu
- Department of Medical Ultrasonics, Institute for Diagnostic and Interventional Ultrasound (L.Z., Z.X., X.X.), and Department of Hepatobiliary Surgery (M.K., M.L.), First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xiaoyan Xie
- Department of Medical Ultrasonics, Institute for Diagnostic and Interventional Ultrasound (L.Z., Z.X., X.X.), and Department of Hepatobiliary Surgery (M.K., M.L.), First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Mingde Lu
- Department of Medical Ultrasonics, Institute for Diagnostic and Interventional Ultrasound (L.Z., Z.X., X.X.), and Department of Hepatobiliary Surgery (M.K., M.L.), First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
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Vardon F, Harrois A, Duranteau J, Geeraerts T. [The initial management in intensive care of pelvic ring injury patients]. ACTA ACUST UNITED AC 2014; 33:344-52. [PMID: 24833399 DOI: 10.1016/j.annfar.2014.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 03/14/2014] [Indexed: 10/25/2022]
Abstract
Pelvic trauma care is complex since it is frequently associated with multiple injuries and may lead to dramatic and uncontrollable haemorrhage. After pelvic trauma, the mortality, around 8 to 10%, is mainly related to severe pelvic hemorrhage but also to extrapelvic injuries (thoracic, abdominal or brain injuries). It is therefore crucial to manage pelvic trauma in specialized trauma center. The initial trauma assessment aims to determine the role of the pelvic injury in hemorrhage to define the therapeutic strategy of pelvic trauma care (arterial embolisation/pelvic ring stabilisation). This review was performed with a systematic review of the literature; it describes the pelvic fracture pathophysiology, and the efficacy and safety of haemostatic procedures and with their respective indications. A decision making algorithm is proposed for the treatment of trauma patients with pelvic fracture.
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Affiliation(s)
- F Vardon
- Pôle anesthésie-réanimation, équipe d'accueil « Modélisation de l'agression tissulaire et nociceptive », université Toulouse 3 Paul-Sabatier, centre hospitalier universitaire de Toulouse, place du Dr-Baylac, 31059 Toulouse cedex 09, France
| | - A Harrois
- Département d'anesthésie-réanimation chirurgicale, centre hospitalier universitaire de Bicêtre, hôpitaux universitaire Paris-Sud, 78, avenue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France
| | - J Duranteau
- Département d'anesthésie-réanimation chirurgicale, centre hospitalier universitaire de Bicêtre, hôpitaux universitaire Paris-Sud, 78, avenue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France
| | - T Geeraerts
- Pôle anesthésie-réanimation, équipe d'accueil « Modélisation de l'agression tissulaire et nociceptive », université Toulouse 3 Paul-Sabatier, centre hospitalier universitaire de Toulouse, place du Dr-Baylac, 31059 Toulouse cedex 09, France.
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Karri JV, Cardenas JC, Johansson PI, Matijevic N, Cotton BA, Wade CE, Holcomb JB. In vitro efficacy of RiaSTAP after rapid reconstitution. J Surg Res 2014; 190:655-61. [PMID: 24602482 DOI: 10.1016/j.jss.2014.01.055] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 01/22/2014] [Accepted: 01/31/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Fibrinogen is the first coagulation factor to reach critical levels during hemorrhage. Consequently, reestablishing normal fibrinogen levels is necessary to achieve adequate hemostasis. Fibrinogen is supplemented through administration of fresh frozen plasma, cryoprecipitate, or human fibrinogen concentrate, RiaSTAP. RiaSTAP is potentially the most advantageous fibrinogen replacement product because it offers the highest fibrinogen concentration, lowest volume, and most consistent dose. Unfortunately, RiaSTAP is limited by a protocol reconstitution time of 15 min. Conversely, physicians in emergency settings frequently resort to a forceful and rapid reconstitution, which causes foaming and possible protein loss and/or damage. This study aims to address the in vitro effectiveness of protocol-reconstituted RiaSTAP versus rapidly reconstituted RiaSTAP versus cryoprecipitate. METHODS Three fibrinogen treatments were prepared: protocol-reconstituted RiaSTAP, rapidly reconstituted RiaSTAP, and thawed cryoprecipitate. Each treatment was added in theoretical doses of 0-600 mg/dL to fibrinogen-depleted plasma (normal fibrinogen level is 150-450 mg/dL). Samples were generated in triplicate, and each sample was subjected to rapid thrombelastography and Clauss assays. The rapid thrombelastography assay measures the hemostatic potential of a blood and/or plasma sample. The maximum amplitude (MA) parameter indicates overall clot strength and is a reflection of fibrinogen efficacy. The Clauss assay measures the time to clot formation in response to a known concentration of thrombin, and the amount of functional fibrinogen is then determined from a standard curve. RESULTS For all fibrinogen treatments, increasing fibrinogen dose resulted in an increase in MA. There was no significant difference in MA between both RiaSTAP reconstitutions (slope of RiaSTAP [protocol], 10.85 mm/[100 mg/dL] and slope of RiaSTAP [rapid], 10.54 mm/[100 mg/dL]). However, both protocol-reconstituted RiaSTAP and rapidly reconstituted RiaSTAP have higher MA values than cryoprecipitate in doses of ≥100 mg/dL. Moreover, each replicate of cryoprecipitate showed a higher variance in fibrinogen efficacy (coefficient of variance [CV] = 44.7%) at a fibrinogen dose of 300 mg/dL. RiaSTAP, however, showed a lower variance in fibrinogen efficacy for both reconstitutions (RiaSTAP [protocol], CV = 3.3% and RiaSTAP [rapid], CV = 2.7%), indicating a consistent fibrinogen dose. CONCLUSIONS RiaSTAP (either reconstitution method) has greater hemostatic potential and less variability in fibrinogen concentration compared with cryoprecipitate. Rapidly reconstituted RiaSTAP does not compromise hemostatic potential and can be used to potentially facilitate hemostasis in rapidly bleeding patients.
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Affiliation(s)
- Jay V Karri
- Center for Translational Injury Research, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Jessica C Cardenas
- Center for Translational Injury Research, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Pär I Johansson
- Center for Translational Injury Research, The University of Texas Health Science Center at Houston, Houston, Texas; Section for Transfusion Medicine, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Nena Matijevic
- Center for Translational Injury Research, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Bryan A Cotton
- Center for Translational Injury Research, The University of Texas Health Science Center at Houston, Houston, Texas; Section for Transfusion Medicine, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Charles E Wade
- Center for Translational Injury Research, The University of Texas Health Science Center at Houston, Houston, Texas; Department of Surgery, The University of Texas Health Science Center at Houston, Houston, Texas
| | - John B Holcomb
- Center for Translational Injury Research, The University of Texas Health Science Center at Houston, Houston, Texas; Department of Surgery, The University of Texas Health Science Center at Houston, Houston, Texas.
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Zentai C, Braunschweig T, Rossaint R, Daniels M, Czaplik M, Tolba R, Grottke O. Fibrin patch in a pig model with blunt liver injury under severe hypothermia. J Surg Res 2013; 187:616-24. [PMID: 24332553 DOI: 10.1016/j.jss.2013.11.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Revised: 11/05/2013] [Accepted: 11/07/2013] [Indexed: 12/14/2022]
Abstract
BACKGROUND Rapid control of hemorrhage is one of the key aspects in trauma handling. To cope with bleeding, local hemostatic approaches are useful, along with surgical and systemic homostatic therapy. In this experimental study, we investigated the efficacy of a fibrinogen/thrombin containing collagen patch (TachoSil) in a coagulopathic pig model with blunt liver trauma under severe hypothermia. METHODS Eighteen anesthetized pigs underwent hemodilution by exchanging 70% of the blood volume with Ringer Lactate solution and hydroxyethyl starch 130/0.4 (1:1). Ten minutes after induction of a grade III blunt liver trauma, the animals randomly received treatment with TachoSil (FT-patch, n = 9) or a collagen patch (Tachotop, control group, n = 9). Blood loss, hemodynamics, and coagulation parameters were observed for 2 h. To confirm the consistency of liver trauma, pathologic examination of the liver tissue was performed. RESULTS Hypothermia (33.5°C ± 0.5°C) and hemodilution led to severe coagulopathy as measured by thromboelastometry and coagulation parameters. After trauma and patch application, thromboelastometry and coagulation parameters in the control group showed further deterioration compared with the stable parameters in the FT-patch group. The total blood loss was significantly reduced in the FT-patch group (FT-patch: 1195 mL; control group: 2495 mL; P < 0.001). Concordantly, the control animals were hemodynamically jeopardized to a higher degree. Microscopy confirmed a similar degree of liver injury. CONCLUSIONS Despite severe hypothermia and coagulopathy, TachoSil provided effective hemorrhage control in pigs with blunt liver injury. Therefore, TachoSil demonstrated usefulness as an additional early therapy in cases of uncontrolled bleeding following severe trauma.
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Affiliation(s)
- Christian Zentai
- Department of Anesthesiology, RWTH Aachen University Hospital, Aachen, Germany; Institute for Laboratory Animal Science, RWTH Aachen University Hospital, Aachen, Germany.
| | - Till Braunschweig
- Department of Pathology, RWTH Aachen University Hospital, Aachen, Germany
| | - Rolf Rossaint
- Department of Anesthesiology, RWTH Aachen University Hospital, Aachen, Germany
| | - Moritz Daniels
- Department of Anesthesiology, RWTH Aachen University Hospital, Aachen, Germany
| | - Michael Czaplik
- Department of Anesthesiology, RWTH Aachen University Hospital, Aachen, Germany
| | - Rene Tolba
- Institute for Laboratory Animal Science, RWTH Aachen University Hospital, Aachen, Germany
| | - Oliver Grottke
- Department of Anesthesiology, RWTH Aachen University Hospital, Aachen, Germany
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