Viscoelastic haemostatic assay augmented protocols for major trauma haemorrhage (ITACTIC): a randomized, controlled trial

PURPOSE

Contemporary trauma resuscitation prioritizes control of bleeding and uses major haemorrhage protocols (MHPs) to prevent and treat coagulopathy. We aimed to determine whether augmenting MHPs with Viscoelastic Haemostatic Assays (VHA) would improve outcomes compared to Conventional Coagulation Tests (CCTs).

METHODS

This was a multi-centre, randomized controlled trial comparing outcomes in trauma patients who received empiric MHPs, augmented by either VHA or CCT-guided interventions. Primary outcome was the proportion of subjects who, at 24 h after injury, were alive and free of massive transfusion (10 or more red cell transfusions). Secondary outcomes included 28-day mortality. Pre-specified subgroups included patients with severe traumatic brain injury (TBI).

RESULTS

Of 396 patients in the intention to treat analysis, 201 were allocated to VHA and 195 to CCT-guided therapy. At 24 h, there was no difference in the proportion of patients who were alive and free of massive transfusion (VHA: 67%, CCT: 64%, OR 1.15, 95% CI 0.76-1.73). 28-day mortality was not different overall (VHA: 25%, CCT: 28%, OR 0.84, 95% CI 0.54-1.31), nor were there differences in other secondary outcomes or serious adverse events. In pre-specified subgroups, there were no differences in primary outcomes. In the pre-specified subgroup of 74 patients with TBI, 64% were alive and free of massive transfusion at 24 h compared to 46% in the CCT arm (OR 2.12, 95% CI 0.84-5.34).

CONCLUSION

There was no difference in overall outcomes between VHA- and CCT-augmented-major haemorrhage protocols.

[Full term tubal pregnancy without rupture of the tube]

From the 17th week, pregnancy was complicated by recurrent abdominal pain. The condition was not recognised until the laparotomy for Cesarian section. The infant and the gestational sac could be removed without difficulty.

Urinary incontinence in 45-year-old women. An epidemiological survey

In an epidemiological health survey, 515 45-year-old women were interviewed about urological problems, particularly incontinence. A pelvic examination was also conducted on 509 of the women. Twenty-two per cent or 114 women stated that they experienced incontinence, which took the form of stress incontinence in 75%, urge incontinence in 11% and a mixture of the two in 14%. Only 14 women, 3% of all the women interviewed, desired medical treatment for incontinence. In the incontinent women, the pelvic examination significantly more often revealed a cystocele, uterine prolapse or impaired function of the levator muscles. No correlation was found between an enlarged uterus and incontinence. In 211 women with one or more of these findings at the gynaecological examination, the frequency of incontinence was 35%; in 298 women with no pathological findings, the frequency was 15%. The frequency of urinary incontinence was not increased in women with higher parity or in postmenopausal women.

Changes in zinc and zinc-dependent enzymes in rheumatoid patients during penicillamine treatment

Zinc in granulocytes, erythrocytes, serum, urine and zinc-dependent enzymes (alkaline phosphatase in serum and granulocytes, carbonic anhydrase in erythrocytes) were measured in patients with rheumatoid arthritis before and during penicillamine therapy for 6 months. The zinc concentration in serum, urine and erythrocytes increased, while granulocyte zinc decreased. Alkaline phosphatase activity in plasma remained unchanged, while alkaline phosphatase in granulocytes decreased. Carbonic anhydrase activity in erythrocytes decreased. None of the changes could be related to the activity of the disease.

Persistent supraventricular tachycardia following infusion with ritodrine hydrochloride

A rare side effect is reported following treatment of preterm labor with ritodrine hydrochloride. The patient developed persistent supraventricular tachycardia, which had to be changed to normal sinus rhythm by cardioconversion.