Comparison of two different coagulation algorithms on the use of allogenic blood products and coagulation factors in severely injured trauma patients: a retrospective, multicentre, observational study

Kaserer, Alexander; Casutt, Mattias; Sprengel, Kai; Seifert, Burkhardt; Spahn, Donat R.; Stein, Philipp

doi:10.1186/s13049-017-0463-0

Cited by 20 publications

(18 citation statements)

References 29 publications

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“…The authors of the European Trauma Treatment Guidelines, for example, believe that education and adhering to coagulation protocols yield the greatest improvement in patient outcomes [7]. Other studies showed that the implementation of such coagulation algorithms indeed reduced patient mortality signi cantly [20,21]. Further, a user-centered design of the treatment protocols also had signi cant positive effects with seven times higher odds ratios of correctly treating a simulated bleeding case [13].…”

Section: Discussionmentioning

confidence: 99%

Step Back and Reassess - What Physicians See as Challenges in Treating Patients with Acute Bleeding: International, Mixed Qualitative and Quantitative Study.

Roche¹,

Wetli²,

Braun³

et al. 2020

Preprint

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Background: Acute bleeding is an omnipresent challenge for all physicians. Uncontrolled hemorrhage is the most common preventable cause of death after trauma worldwide. In different surgical disciplines, hemorrhage represents an independent risk factor for increased postoperative morbimortality, directly affecting patients’ outcomes. This study asked anesthesiologists about their personal perceived challenges when treating bleeding patients. Methods: This investigator-initiated, prospective, international, dual-center, mixed qualitative and quantitative study interrogated anesthesiologists about what they found easy and what difficult in treating acutely bleeding patients. Following the template approach for qualitative research, we identified major and minor topics through free inductive coding and word count. In a second step, we derived ten statements from the participants’ answers. Using a field survey, we then asked the participants to rate their level of agreement with the derived statements. We analyzed the answers using one sample Wilcoxon test and the Mann-Whitney test. Results: We included a total of 84 physicians in the qualitative interrogations and a different group of 42 anesthesiologists in the quantitative part. We identified 11 major topics and 19 associated subtopics. The main topics and the degree of agreement (here as agree or strongly agree) were as follows: “Complexity of the topic” (52.4% agreed to find the topic complex), “Cognitive aids” (92.9% agreed to find them helpful), “Time management” (64.3% agreed to feeling time pressure), “Human factors” (95.2% agreed that human factors are essential), “Resources” (95.2% agreed that resources are essential), “Experience” and “Low frequency of cases” (57.1% agreed to lack practice), “Diagnostic methods” (31.0% agreed that the interpretation of test results is difficult), “Anticoagulation” (85.7% agreed to it being difficult), “Treatment” (81.0% agreed to knowing the first therapeutic steps), and “Nothing”.Conclusions: Anesthesiologists in two large tertiary care facilities in different parts of the world found coagulation management, especially in anticoagulated patients, complex. We identified the delayed diagnostic test results and their interpretation as challenges. Resources, treatment protocols and human factors such as team communication were perceived to facilitate management. Future studies should explore the challenges in smaller hospitals and other parts of the world and test new technologies addressing the identified difficulties.

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Section: Discussionmentioning

confidence: 99%

Step Back and Reassess - What Physicians See as Challenges in Treating Patients with Acute Bleeding: International, Mixed Qualitative and Quantitative Study.

Roche¹,

Wetli²,

Braun³

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…Nevertheless, it may also suggest different transfusion habits between both countries, especially, as transfusion habits in certain Swiss-level-one trauma centers changed markedly within the last decade [28]. Swiss transfusion rates probably dropped due to the implementation of a goal-directed coagulation algorithm, and increasing utilization of tranexamic acid and coagulation factor XIII [28,29].…”

Section: Despite Equal Injury Severity and A Comparable Amountmentioning

confidence: 99%

Pre-hospital trauma care in Switzerland and Germany: do they speak the same language?

Jensen

Teuben

Lefering

et al. 2020

Eur J Trauma Emerg Surg

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Purpose Swiss and German (pre-)hospital systems, distribution and organization of trauma centres differ from each other. It is unclear if outcome in trauma patients differs as well. Therefore, this study aims to determine differences in characteristics, therapy and outcome of trauma patients between both German-speaking countries. Methods The TraumaRegister DGU ® (TR-DGU) was used. Patients with Injury Severity Score ≥ 9 admitted to a level 1 trauma centre between 01/2009 and 12/2017 were included if they required ICU care or died. Trauma pattern, pre-hospital procedures and outcome were compared between Swiss (CH, n = 4768) and German (DE, n = 66,908) groups. Results Swiss patients were older than German patients (53 vs. 50 years). ISS did not differ between groups (CH 23.8 vs. DE 23.0 points). There were more low falls < 3 m (34% vs. 21%) at the expense of less traffic accidents (37% vs. 52%) in the Swiss population. In Switzerland 30% of allocations were done without physician involvement, whereas this occurred in 4% of German cases. Despite a comparable number of patients with a GCS ≤ 8 (CH 29.6%; DE 26.4%), differences in prehospital intubation rates occurred (CH 31% vs. DE 40%). Severe traumatic brain injuries were diagnosed most frequently in Switzerland (CH 62% vs. DE 49%). Admission vital signs were similar, and standardized mortality ratios were close to one in both countries. Conclusion This study demonstrates that patients' age, trauma patterns and pre-hospital care differ between Germany and Switzerland. However, adjusted mortality was almost similar. Further benchmarking studies are indicated to optimize trauma care in both German-speaking countries.

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“…The principle goal of CFC-based treatment strategies is to reduce transfusion rates of allogeneic blood products and associated risks like anaphylactic reactions, transfusion related acute lung injury, multiorgan failure and severe infections 7 . The clinical effectiveness of CFCs in this context has been demonstrated in a large number of clinical trials and current scienti c rationale exists to support CFC repletion in patients with ongoing bleeding and con rmed coagulation factor de ciency 8,9,10 . By contrast there is certain paucity of high-quality evidence in favor of plasma when compared to CFC containing products, although plasma transfusion is still a widely accepted standard of trauma and non-trauma massive transfusion protocols (MTP) 11 .…”

Section: Introductionmentioning

confidence: 99%

Normalization of Blood Clotting Characteristics Using Prothrombin Complex Concentrate, Fibrinogen and Fxiii In an Albumin Based Fluid: Experimental Studies In Thromboelastometry.

Koller

Kinast

Castellanos

et al. 2020

Preprint

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Background: Colloid fluids supplemented with adequate combinations of coagulation factor concentrates with capability to restore coagulation could be a desirable future treatment component in massive transfusion.Methods: Starting from a coagulation factor and blood cell free albumin solution we added Prothrombin Complex Concentrate, Fibrinogen Concentrate and Factor XIII in different combinations and concentrations to analyze their properties to restore thromboelastometry parameters without the use of plasma. Further analysis under presence of platelets was performed for comparability to whole blood conditions.Results: Albumin solutions enriched with Fibrinogen Concentrate, Factor XIII and Prothrombin Complex Concentrate at optimized concentrations show restoring coagulation potential. Prothrombin Complex Concentrate showed sufficient thrombin formation for inducing fibrinogen polymerization. The combination of Prothrombin Complex Concentrate and Fibrinogen Concentrate led to the formation of a stable in vitro fibrin clot. Fibrinogen and Factor XIII showed excellent capacity to improve fibrin clot firmness expressed as Amplitude at 10 minutes and Maximal Clot Firmness. Fibrinogen alone, or in combination with Factor XIII, was able to restore normal Amplitude at 10 minutes and Maximal Clot Firmness values. In the presence of platelets, the thromboelastometry surrogate parameter for thrombin generation (Clotting Time) improves and normalizes when compared to whole blood.Conclusions: Combinations of coagulation factor concentrates suspended in albumin solutions have the capacity to restore thromboelastometry parameters in the absence of plasma. This kind of artificial colloid fluids with coagulation-restoring characteristics might offer new treatment alternatives for massive transfusion.Trial registration: Study registered at the institutional ethic committee “Institut de Recerca, Hospital Santa Creu i Sant Pau, with protocol number IIBSP-CFC-2013-165.

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Comparison of two different coagulation algorithms on the use of allogenic blood products and coagulation factors in severely injured trauma patients: a retrospective, multicentre, observational study

Cited by 20 publications

References 29 publications

Step Back and Reassess - What Physicians See as Challenges in Treating Patients with Acute Bleeding: International, Mixed Qualitative and Quantitative Study.

Step Back and Reassess - What Physicians See as Challenges in Treating Patients with Acute Bleeding: International, Mixed Qualitative and Quantitative Study.

Pre-hospital trauma care in Switzerland and Germany: do they speak the same language?

Normalization of Blood Clotting Characteristics Using Prothrombin Complex Concentrate, Fibrinogen and Fxiii In an Albumin Based Fluid: Experimental Studies In Thromboelastometry.

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