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Tama MA, Stone ME, Blumberg SM, Reddy SH, Conway EE, Meltzer JA. Association of Cryoprecipitate Use With Survival After Major Trauma in Children Receiving Massive Transfusion. JAMA Surg 2021; 156:453-460. [PMID: 33595600 DOI: 10.1001/jamasurg.2020.7199] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Although most massive transfusion protocols incorporate cryoprecipitate in the treatment of hemorrhaging injured patients, minimal data exist on its use in children, and whether its addition improves their survival is unclear. Objective To determine whether cryoprecipitate use for injured children who receive massive transfusion is associated with lower mortality. Design, Setting, and Participants This retrospective cohort study included injured patients examined between January 1, 2014, and December 31, 2017, at one of multiple centers across the US and Canada participating in the Pediatric Trauma Quality Improvement Program. Patients were aged 18 years or younger and had received massive transfusion, which was defined as at least 40 mL/kg of total blood products in the first 4 hours after emergency department arrival. Exclusion criteria included hospital transfer, arrival without signs of life, time of death or hospital discharge not recorded, and isolated head injuries. To adjust for potential confounding, a propensity score for treatment was created and inverse probability weighting was applied. The propensity score accounted for age, sex, race/ethnicity, injury type, payment type, Glasgow Coma Scale score, hypoxia, hypotension, assisted respirations, chest tube status, Injury Severity Score, total volume of blood products received, hemorrhage control procedure, hospital size, academic status, and trauma center designation. Data were analyzed from December 11, 2019, to August 31, 2020. Exposures Cryoprecipitate use within the first 4 hours of emergency department arrival. Main Outcomes and Measures In-hospital 24-hour and 7-day mortality. Results Of the 2387 injured patients who received massive transfusion, 1948 patients were eligible for analysis. The median age was 16 years (interquartile range, 9-17 years), 1382 patients (70.9%) were male, and 807 (41.4%) were White. A total of 541 patients (27.8%) received cryoprecipitate. After propensity score weighting, patients who received cryoprecipitate had a significantly lower 24-hour mortality when compared with those who did not (adjusted difference, -6.9%; 95% CI, -10.6% to -3.2%). Moreover, cryoprecipitate use was associated with a significantly lower 7-day mortality but only in children with penetrating trauma (adjusted difference, -9.2%; 95% CI, -15.4% to -3.0%) and those transfused at least 100 mL/kg of total blood products (adjusted difference, -7.7%; 95% CI, -15.0% to -0.5%). Conclusions and Relevance In this cohort study, early use of cryoprecipitate was associated with lower 24-hour mortality among injured children who required massive transfusion. The benefit of cryoprecipitate appeared to persist for 7 days only in those with penetrating trauma and in those who received extremely large-volume transfusion.
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Affiliation(s)
- Maria A Tama
- Division of Pediatrics, Department of Emergency Medicine, Staten Island University Hospital, Staten Island, New York
| | - Melvin E Stone
- Division of Trauma, Department of Surgery, Jacobi Medical Center, Bronx, New York
| | - Stephen M Blumberg
- Division of Emergency Medicine, Department of Pediatrics, Jacobi Medical Center, Bronx, New York
| | - Srinivas H Reddy
- Division of Trauma, Department of Surgery, Jacobi Medical Center, Bronx, New York
| | - Edward E Conway
- Division of Critical Care, Department of Pediatrics, Jacobi Medical Center, Bronx, New York
| | - James A Meltzer
- Division of Emergency Medicine, Department of Pediatrics, Jacobi Medical Center, Bronx, New York
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Spagnolello O, J Reed M, Dauncey S, Timony-Nolan E, Innes C, Allen JMM, Williams MJ, Church N, Dunn MJG, Blackstock C, Nimmo AF. Introduction of a ROTEM protocol for the management of trauma-induced coagulopathy. TRAUMA-ENGLAND 2020. [DOI: 10.1177/1460408620957919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Aims Point-of-care viscoelastic tests such as rotational thrombelastometry (ROTEM) and thromboelastography (TEG) give rapid information on the kinetics of clot formation, clot strength and fibrinolysis. We developed a ROTEM algorithm for the management of trauma patients at risk of massive haemorrhage using either 5 or 10 minute EXTEM and FIBTEM ROTEM thresholds. Study aims were (a) to compare time to results for ROTEM testing versus laboratory conventional coagulation testing (CCT) and (b) to compare incidence of Trauma-induced coagulopathy (TIC) for our 5 and 10 minute ROTEM algorithms versus both the CCT-based European guideline algorithm and the ROTEM-based iTACTIC study algorithm, in both MT and non-MT patients. Methods Single centre, prospective, observational Emergency Department based study. All trauma patients who underwent ROTEM testing were included. Data was collected from the ROTEM Sigma machine and hospital Electronic Patient Records and analysed. Results Between April 2016 and May 2019, 57 trauma patients were enrolled. Mean age was 47.4 years (SD 19.4) and 44 patients (77.2%) were male. Eleven patients (19.3%) required massive transfusion (MT), 5 patients died in ED (8.8%) and overall in-hospital mortality was 22.8% (n = 13). Median time from admission to CCT result was 83 minutes (IQR 60–93) compared to 51 minutes (IQR 32-93; p = 0.0006) for ROTEM A5 results. This time difference was present for both MT and non-MT patients. Trauma-induced coagulopathy (TIC) was identified in 14 (24.5%) patients using CCT compared to 22 (38.5%) using ROTEM (p = 0.11 ns). Conclusion Our ROTEM Sigma based algorithm enables a coagulation result to be obtained faster than laboratory CCT and could lead to earlier clinical intervention.
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Affiliation(s)
- Ornella Spagnolello
- Emergency Medicine Research Group Edinburgh (EMERGE), Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Matthew J Reed
- Emergency Medicine Research Group Edinburgh (EMERGE), Royal Infirmary of Edinburgh, Edinburgh, UK
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Steve Dauncey
- Department of Emergency Medicine, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
| | - Emer Timony-Nolan
- Department of Emergency Medicine, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
| | - Catherine Innes
- SNBTS Transfusion Team, Scottish National Blood Transfusion Service, Edinburgh, UK
| | - Jennifer MM Allen
- SNBTS Transfusion Team, Scottish National Blood Transfusion Service, Edinburgh, UK
| | - Michael J Williams
- Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
| | - Nick Church
- Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
| | - Mark JG Dunn
- Department of Critical Care, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
| | - Caroline Blackstock
- Emergency Medicine Research Group Edinburgh (EMERGE), Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Alastair F Nimmo
- Department of Anaesthetics, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
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Spahn DR, Bouillon B, Cerny V, Duranteau J, Filipescu D, Hunt BJ, Komadina R, Maegele M, Nardi G, Riddez L, Samama CM, Vincent JL, Rossaint R. The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition. Crit Care 2019; 23:98. [PMID: 30917843 PMCID: PMC6436241 DOI: 10.1186/s13054-019-2347-3] [Citation(s) in RCA: 688] [Impact Index Per Article: 137.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 02/06/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Severe traumatic injury continues to present challenges to healthcare systems around the world, and post-traumatic bleeding remains a leading cause of potentially preventable death among injured patients. Now in its fifth edition, this document aims to provide guidance on the management of major bleeding and coagulopathy following traumatic injury and encourages adaptation of the guiding principles described here to individual institutional circumstances and resources. METHODS The pan-European, multidisciplinary Task Force for Advanced Bleeding Care in Trauma was founded in 2004, and the current author group included representatives of six relevant European professional societies. The group applied a structured, evidence-based consensus approach to address scientific queries that served as the basis for each recommendation and supporting rationale. Expert opinion and current clinical practice were also considered, particularly in areas in which randomised clinical trials have not or cannot be performed. Existing recommendations were re-examined and revised based on scientific evidence that has emerged since the previous edition and observed shifts in clinical practice. New recommendations were formulated to reflect current clinical concerns and areas in which new research data have been generated. RESULTS Advances in our understanding of the pathophysiology of post-traumatic coagulopathy have supported improved management strategies, including evidence that early, individualised goal-directed treatment improves the outcome of severely injured patients. The overall organisation of the current guideline has been designed to reflect the clinical decision-making process along the patient pathway in an approximate temporal sequence. Recommendations are grouped behind the rationale for key decision points, which are patient- or problem-oriented rather than related to specific treatment modalities. While these recommendations provide guidance for the diagnosis and treatment of major bleeding and coagulopathy, emerging evidence supports the author group's belief that the greatest outcome improvement can be achieved through education and the establishment of and adherence to local clinical management algorithms. CONCLUSIONS A multidisciplinary approach and adherence to evidence-based guidance are key to improving patient outcomes. If incorporated into local practice, these clinical practice guidelines have the potential to ensure a uniform standard of care across Europe and beyond and better outcomes for the severely bleeding trauma patient.
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Affiliation(s)
- Donat R. Spahn
- Institute of Anaesthesiology, University of Zurich and University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland
| | - Bertil Bouillon
- Department of Trauma and Orthopaedic Surgery, Cologne-Merheim Medical Centre (CMMC), University of Witten/Herdecke, Ostmerheimer Strasse 200, D-51109 Cologne, Germany
| | - Vladimir Cerny
- Department of Anaesthesiology, Perioperative Medicine and Intensive Care, J.E. Purkinje University, Masaryk Hospital, Usti nad Labem, Socialni pece 3316/12A, CZ-40113 Usti nad Labem, Czech Republic
- Centre for Research and Development, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic, Sokolska 581, CZ-50005 Hradec Kralove, Czech Republic
- Department of Anaesthesiology and Intensive Care Medicine, Faculty of Medicine in Hradec Kralove, Charles University, Simkova 870, CZ-50003 Hradec Kralove, Czech Republic
- Department of Anaesthesia, Pain Management and Perioperative Medicine, QE II Health Sciences Centre, Dalhousie University, Halifax, 10 West Victoria, 1276 South Park St, Halifax, NS B3H 2Y9 Canada
| | - Jacques Duranteau
- Department of Anaesthesia and Intensive Care, Hôpitaux Universitaires Paris Sud, University of Paris XI, Faculté de Médecine Paris-Sud, 78 rue du Général Leclerc, F-94275 Le Kremlin-Bicêtre Cedex, France
| | - Daniela Filipescu
- Department of Cardiac Anaesthesia and Intensive Care, C. C. Iliescu Emergency Institute of Cardiovascular Diseases, Sos Fundeni 256-258, RO-022328 Bucharest, Romania
| | - Beverley J. Hunt
- King’s College and Departments of Haematology and Pathology, Guy’s and St Thomas’ NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH UK
| | - Radko Komadina
- Department of Traumatology, General and Teaching Hospital Celje, Medical Faculty Ljubljana University, SI-3000 Celje, Slovenia
| | - Marc Maegele
- Department of Trauma and Orthopaedic Surgery, Cologne-Merheim Medical Centre (CMMC), Institute for Research in Operative Medicine (IFOM), University of Witten/Herdecke, Ostmerheimer Strasse 200, D-51109 Cologne, Germany
| | - Giuseppe Nardi
- Department of Anaesthesia and ICU, AUSL della Romagna, Infermi Hospital Rimini, Viale Settembrini, 2, I-47924 Rimini, Italy
| | - Louis Riddez
- Department of Surgery and Trauma, Karolinska University Hospital, S-171 76 Solna, Sweden
| | - Charles-Marc Samama
- Hotel-Dieu University Hospital, 1, place du Parvis de Notre-Dame, F-75181 Paris Cedex 04, France
| | - Jean-Louis Vincent
- Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik 808, B-1070 Brussels, Belgium
| | - Rolf Rossaint
- Department of Anaesthesiology, University Hospital Aachen, RWTH Aachen University, Pauwelsstrasse 30, D-52074 Aachen, Germany
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Shi W, Al-Sabti R, Burke PA, Gonzalez M, Mantilla-Rey N, Quillen K. Quality Management of massive transfusion protocol incorporating tranexamic acid adherence. Transfus Apher Sci 2018; 57:785-789. [PMID: 30455154 DOI: 10.1016/j.transci.2018.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 09/22/2018] [Accepted: 10/16/2018] [Indexed: 11/16/2022]
Abstract
Massive transfusion protocols (MTP) vary at different institutions. We implemented an algorithm in the transfusion service to support our Level I trauma center in 2007 and periodically monitor MTP utilization as part of ongoing quality management. At the last review in 2013, median plasma: RBC ratio was 1:1.8. We undertook a retrospective 3-year review of MTP activations stratifying by trauma versus non-trauma indications, and blood component utilization of the massive transfusion (MT) cases, adding a review of tranexamic acid (TXA) administration to the audit. The median transfused plasma: RBC ratio was 1:1.9 in trauma MT, and 1:1.6 in the non-trauma MT cases. Non-trauma MT patients at our institution were significantly older and more coagulopathic at MTP initiation compared to trauma MT patients, received fewer RBC units (15.5 versus 20.2), and had higher mortality. TXA adherence increased over the 3-year period to 60% of all trauma MTP activations in 2017.
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Affiliation(s)
- Weiwei Shi
- Department of Pathology and Laboratory Medicine, Boston University Medical Center, Boston, MA, 02118, United States.
| | - Ram Al-Sabti
- Department of Pathology and Laboratory Medicine, Boston University Medical Center, Boston, MA, 02118, United States
| | - Peter A Burke
- Department of Surgery, Boston University Medical Center, United States
| | - Mauricio Gonzalez
- Department of Anesthesiology, Boston University Medical Center, United States
| | - Nelson Mantilla-Rey
- Department of Pathology and Laboratory Medicine, Boston University Medical Center, Boston, MA, 02118, United States
| | - Karen Quillen
- Department of Pathology and Laboratory Medicine, Boston University Medical Center, Boston, MA, 02118, United States
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Culler CA, Iazbik C, Guillaumin J. Comparison of albumin, colloid osmotic pressure, von Willebrand factor, and coagulation factors in canine cryopoor plasma, cryoprecipitate, and fresh frozen plasma. J Vet Emerg Crit Care (San Antonio) 2017; 27:638-644. [PMID: 29064153 DOI: 10.1111/vec.12671] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 03/21/2016] [Accepted: 06/16/2016] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To compare albumin concentrations, coagulation factors activity, and colloid osmotic pressure (COP) of cryoprecipitate (CRYO) and cryopoor plasma (CPP) to that of source fresh frozen plasma (FFP). DESIGN Prospective in vitro study. SETTING University teaching hospital. ANIMALS Ten healthy, non-Greyhound dogs enrolled in an academic teaching hospital blood donor program. INTERVENTIONS Fresh blood was obtained from canine blood donors and separated into FFP and packed red blood cells. The source FFP was further separated into CRYO and CPP. Albumin and fibrinogen concentrations, COP, activities of coagulation factors II, V, VII, VIII, IX, X, and von Willebrand factor (vWf) were assessed for each FFP, CRYO, and CPP. MEASUREMENTS AND MAIN RESULTS The mean albumin concentration and COP in CPP were significantly higher compared with those found in FFP, with 31.7 g/L (±6) in CPP compared to 28.9 g/L (±0.5) in FFP (P < 0.001) and 14.5 mm Hg (±0.7) in CPP compared to 12.7 mm Hg (±0.3) in FFP (P = 0.03), respectively. CRYO had significantly higher concentrations of fibrinogen (median 3.46 g/L, 95% CI 2.65-4.27), and higher activities of factor VIII (mean activity 427.0%, ±95.4) and vWf (mean activity 504.7%, ±41.39) as compared to the other products. The activities of vitamin K dependent factors II, VII, and X were similar in CPP compared to FFP, although factor IX activity was lower in CPP. There was no significant difference in factor II or VII activities between the 3 products. CONCLUSIONS The mean albumin concentration and COP were highest in CPP, suggesting that CPP may be a potential alternative to FFP for oncotic support and albumin replacement. CRYO contained higher activities of vWf and factor VIII than other products and could be used to treat vWf deficiency and hemophilia A. As vitamin K dependent coagulation factors II, VII, and X in CPP were similar to FFP, CPP may be an option for replacement of most of vitamin K dependent factors.
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Affiliation(s)
- Christine A Culler
- Department of Veterinary Clinical Sciences, The Ohio State University Veterinary Medical Center, Columbus, OH 43210
| | - Cristina Iazbik
- Department of Veterinary Clinical Sciences, The Ohio State University Veterinary Medical Center, Columbus, OH 43210
| | - Julien Guillaumin
- Department of Veterinary Clinical Sciences, The Ohio State University Veterinary Medical Center, Columbus, OH 43210
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Haemotherapy algorithm for the management of trauma-induced coagulopathy: an Australian perspective. Curr Opin Anaesthesiol 2017; 30:265-276. [PMID: 28151829 DOI: 10.1097/aco.0000000000000447] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE OF REVIEW Recent advances in the understanding of the pathophysiological processes associated with traumatic haemorrhage and trauma-induced coagulopathy have resulted in improved outcomes for seriously injured trauma patients. However, a significant number of trauma patients still die from haemorrhage. This article reviews the various transfusion strategies utilized in the management of traumatic haemorrhage and describes the major haemorrhage protocol (MHP) strategy employed by an Australian trauma centre. RECENT FINDINGS Few topics in trauma resuscitation incite as much debate and controversy as to what constitutes the 'ideal' MHP. There is a widespread geographical and institutional variation in clinical practice. Three strategies are commonly utilized; fixed ratio major haemorrhage protocol (FRMHP), viscoelastic haemostatic assay (VHA)-guided MHP and hybrid MHP. The majority of trauma centres utilize an FRMHP and there is high-level evidence to support the use of high blood product ratios. It can be argued that the FRMHP is too simplistic to be applied to all trauma patients and that the use of VHA-guided MHP with predominant factor concentrate transfusion can allow rapid individualized interventions. In between these two strategies is a hybrid MHP, combining early FRMHP with subsequent VHA-guided transfusion. SUMMARY There are advantages and disadvantages to each of the various MHP strategies and the evidence base to support one above another with any certainty is lacking at this time. One strategy cannot be considered superior to the other and the choice of MHP is dependent on interpretation of the current literature and local institutional logistical considerations. A number of exciting studies are currently underway that will certainly increase the evidence base and help inform clinical practice.
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Ruseckaite R, McQuilten ZK, Oldroyd JC, Richter TH, Cameron PA, Isbister JP, Wood EM. Descriptive characteristics and in-hospital mortality of critically bleeding patients requiring massive transfusion: results from the Australian and New Zealand Massive Transfusion Registry. Vox Sang 2017; 112:240-248. [DOI: 10.1111/vox.12487] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 11/10/2016] [Accepted: 12/10/2016] [Indexed: 11/29/2022]
Affiliation(s)
- R. Ruseckaite
- Department of Epidemiology and Preventive Medicine; Monash University; Melbourne Vic. Australia
| | - Z. K. McQuilten
- Department of Epidemiology and Preventive Medicine; Monash University; Melbourne Vic. Australia
| | - J. C. Oldroyd
- Department of Epidemiology and Preventive Medicine; Monash University; Melbourne Vic. Australia
| | - T. H. Richter
- Department of Epidemiology and Preventive Medicine; Monash University; Melbourne Vic. Australia
| | - P. A. Cameron
- Department of Epidemiology and Preventive Medicine; Monash University; Melbourne Vic. Australia
- Emergency and Trauma Centre; The Alfred Hospital; Melbourne Vic. Australia
| | - J. P. Isbister
- Department of Haematology; Royal North Shore Hospital; University of Sydney; St Leonards NSW Australia
| | - E. M Wood
- Department of Epidemiology and Preventive Medicine; Monash University; Melbourne Vic. Australia
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Mizobata Y. Damage control resuscitation: a practical approach for severely hemorrhagic patients and its effects on trauma surgery. J Intensive Care 2017; 5:4. [PMID: 34798697 PMCID: PMC8600903 DOI: 10.1186/s40560-016-0197-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 12/17/2016] [Indexed: 02/07/2023] Open
Abstract
Coagulopathy observed in trauma patients was thought to be a resuscitation-associated phenomenon. The replacement of lost and consumed coagulation factors was the mainstay in the resuscitation of hemorrhagic shock for many decades. Twenty years ago, damage control surgery (DCS) was implemented to challenge the coagulopathy of trauma. It consists of three steps: abbreviated surgery to control the hemorrhage and contamination, resuscitation in the intensive care unit (ICU), and planned re-operation with definitive surgery. The resuscitation strategy of DCS focused on the rapid reversal of acidosis and prevention of hypothermia through the first two steps. However, direct treatment of coagulopathy was not emphasized in DCS. Recently, better understanding of the pathophysiology of coagulopathy in trauma patients has led to the logical opinion that we should directly address this coagulopathy during major trauma resuscitation. Damage control resuscitation (DCR), the strategic approach to the trauma patient who presents in extremis, consists of balanced resuscitation, hemostatic resuscitation, and prevention of acidosis, hypothermia, and hypocalcemia. In balanced resuscitation, fluid administration is restricted and hypotension is allowed until definitive hemostatic measures begin. The administration of blood products consisting of fresh frozen plasma, packed red blood cells, and platelets, the ratio of which resembles whole blood, is recommended early in the resuscitation. DCR strategy is now the most beneficial measure available to address trauma-induced coagulopathy, and it can change the treatment strategy of trauma patients. DCS is now incorporated as a component of DCR. DCR as a structured intervention begins immediately after rapid initial assessment in the emergency room and progresses through the operating theater into the ICU in combination with DCS. By starting from ground zero with the performance of DCS, DCR allows the trauma surgeon to correct the coagulopathy of trauma. The effect of the reversal of coagulopathy in massively hemorrhagic patients may change the operative strategy with DCS.
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Okerberg CK, Williams LA, Kilgore ML, Kim CH, Marques MB, Schwartz J, Pham HP. Cryoprecipitate AHF vs. fibrinogen concentrates for fibrinogen replacement in acquired bleeding patients - an economic evaluation. Vox Sang 2016; 111:292-298. [DOI: 10.1111/vox.12417] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 04/20/2016] [Accepted: 04/24/2016] [Indexed: 11/29/2022]
Affiliation(s)
- C. K. Okerberg
- Department of Health Care Organization and Policy; University of Alabama at Birmingham; Birmingham AL USA
| | - L. A. Williams
- Department of Pathology; University of Alabama at Birmingham; Birmingham AL USA
| | - M. L. Kilgore
- Department of Health Care Organization and Policy; University of Alabama at Birmingham; Birmingham AL USA
| | - C. H. Kim
- Department of Clinical Pharmacy; University of Colorado Anschutz Medical Campus; Aurora CO USA
| | - M. B. Marques
- Department of Pathology; University of Alabama at Birmingham; Birmingham AL USA
| | - J. Schwartz
- Department of Pathology and Cell Biology; Columbia University Medical Center and the New York-Presbyterian Hospital; New York NY USA
| | - H. P. Pham
- Department of Pathology; University of Alabama at Birmingham; Birmingham AL USA
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Abstract
Introduction Massive hemorrhage remains a major cause of potentially preventable deaths. Better control of bleeding could improve survival rates by 10%–20%. Transfusion intervention concepts have been formulated in order to minimize acute traumatic coagulopathy. These interventions still have not been standardized and vary among medical centers. Materials and Methods Based on a literature search using free term keywords and Medical Subject Heading (MeSH) index, we analyzed published articles addressing massive hemorrhage, component therapy, fresh whole blood, and fibrinogen from the year 2000 onward, in journals with impact factor >1.000, in Medline, PubMed, and Google Scholar. The evidence was grouped into topics including laboratory testing and transfusion interventions/viscoelastic assays vs standard laboratory tests, the effect of component therapy on patient outcome, the effect of warm fresh whole blood on patient outcome, and the effects of fibrinogen in severe bleeding. The obtained information was compared, evaluated, confronted, and was focused on to present an adequate and individual-based massive hemorrhage management approach. Results Viscoelastic whole-blood assays are superior to standard coagulation blood tests for the identification of coagulopathy and for guiding decisions on appropriate therapy in patients with severe bleeding. Replacement of plasma, red blood cells, platelets, and fibrinogen in a ratio of 1:1:1:1 has appeared to be the best substitution for lost whole blood. There is no evidence that cryoprecipitate improves the outcome of patients with severe hemorrhage. Current literature promotes the transfusion of warm fresh whole blood, which seems to be superior to the component therapy in certain clinical situations. Some authors recommend that fibrinogen and other coagulation factors be administered according to the viscoelastic attributes of the blood clot. Conclusion This best-evidence topic report brings comprehensive information about massive hemorrhage management.
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Affiliation(s)
- Tomas Vymazal
- Department of Anesthesiology and Intensive Care Medicine, 2nd Faculty of Medicine Charles University, University Hospital Motol, Prague, Czech Republic
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