Early and individualized goal-directed therapy for trauma-induced coagulopathy

Schöchl, Herbert; Maegele, Marc; Solomon, Cristina; Görlinger, Klaus; Voelckel, Wolfgang G.

doi:10.1186/1757-7241-20-15

Cited by 187 publications

(197 citation statements)

References 93 publications

(123 reference statements)

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“…If a viscoelastic monitoring is available, the ECS protocol recommend to treat the patients who need MT with the administration of plasma with the addition of factors, following the goal-directed algorithm presented in Table 2. Treatment goals has been adapted from the AUVA Protocol [65] which is based on rotational thromboelastometry (ROTEM). Thromboelastography (TEG) might provide the same information.…”

Section: Resultsmentioning

confidence: 99%

Prevention and treatment of trauma induced coagulopathy (TIC). An intended protocol from the Italian trauma update research group

Agostini¹,

Rondinelli²,

Bocci³

et al. 2013

J Anesthesiol Clin Sci

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In recent years, a strong focus has been put on the need to assure early coagulation support in order to prevent and treat coagulopathy in patients with severe trauma, and to improve survival. Aggressive plasma administration with high plasma/ red blood cells ratio is increasingly used worldwide. However, plasma transfusion is associated with increased risks of multiple organ dysfunction syndrome (MODS), adult respiratory distress syndrome (ARDS) and infection, which may prolong hospital stay and the need for artificial ventilation. Moreover, in the majority of European hospitals plasma cannot be immediately available and therefore it has been reported a significant delay in coagulation support. This has lead to the proposal of using clotting factors as an alternative to plasma. However, strong evidence to define the best strategy is still missing, and the only published protocols are Institution-specific, thus depending on the local organization and the available resources. The Italian Trauma Centers Network (TUN) recently developed a treatment protocol aiming at shortening the interval before the onset of coagulation support and at reducing the use of plasma. We present this protocol-Early Coagulation Support (ECS) Protocol -and discuss its rationale. Its implications for the trauma-team workflow and hospital organization are also addressed. The ECS protocol must be considered as an integrated part of a comprehensive Damage Control Strategy. The impact of the ECS Protocol on blood products consumption, trauma mortality and morbidity as well as its financial aspects, will be strictly monitored by the TUN hospitals.

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Section: Resultsmentioning

confidence: 99%

Prevention and treatment of trauma induced coagulopathy (TIC). An intended protocol from the Italian trauma update research group

Agostini¹,

Rondinelli²,

Bocci³

et al. 2013

J Anesthesiol Clin Sci

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“…If the patient is coagulopathic, it is better to specify the cause of coagulopathy. Because studies have shown that co-administration with FFP plasma and packed RBCs reduces mortality in severe trauma cases, the administration of FFP in these cases has greatly increased (14).…”

Section: Discussionmentioning

confidence: 99%

Survey of Poly Fibrinogen Levels in Patients With Major Blunt Trauma

et al. 2015

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Background: Coagulopathy is common after severe trauma or massive bleeding, and many studies have shown the benefits of coadministration of blood and plasma. Efforts are being made to improve the treatment of patients injured by blunt trauma using plasma infusion. Objectives: This study focused on blood fibrinogen levels in patients with severe trauma and bleeding. Patients and Methods: Twenty-eight patients who were admitted to the Rajaee (Emtiaz) Trauma Hospital were studied in this crosssectional survey, which was conducted in August and September of 2013. The patients were male and over 16 years old, with an injury severity score greater than or equal to 16, diastolic blood pressure under 90 mmHg, a minimum 1500 cc of estimated blood loss, and a minimum of 2000 cc crystalloid fluid intake, and patients were not receiving blood or blood products at the time of the traumatic event. Upon patient arrival, blood samples were obtained to measure fibrinogen concentration before starting resuscitation for the patient. Administration of blood and blood products was then performed according to hospital protocol. Results: Over three months, twenty eight patients were admitted with the above criteria. Among these patients, the fibrinogen levels of eight cases (28.57%) were reported as non-measurable. Fibrinogen levels in 10% of the patients were below the acceptable standard of admission to the center, which means that blood fibrinogen levels were lower than normal in a significant number of patients. Conclusions: Severe tissue damage and bleeding significantly reduce fibrinogen levels, and the positive effects of administering plasma to severe trauma patients may be due to the fibrinogen that plasma provides. It is therefore important to discover safer ways to administer fibrinogen. We recommend that the amount of administered fibrinogen be controlled, and that a thromboelastography be conducted for all patients on arrival.

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“…Uncontrollable bleeding accounts for up to 40% of trauma-related deaths and is the leading cause of potentially preventable death in patients with major trauma [4,5]. Massive haemorrhage and subsequent Massive Transfusion (MT) are frequent complications of trauma and surgery [6,7].…”

Section: Introductionmentioning

confidence: 99%

“…The mortality rate was 11.4% (12/105) and these were mainly related to underlying trauma rather than DIC with the exception of 1 patient. The average number of transfused PRBC was 15 units (range, 6-42); cryoprecipitate, 20(range, 10-60); platelets, 2(range, 1-7) and FFP, 8(range,[2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. …”

mentioning

confidence: 99%

Application of Massive Transfusion Protocol is Associated with a Low Incidence of Coagulopathy and Mortality Rate

Khalafallah¹

2012

J Blood Disord Transfus

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Background: Massive haemorrhage and subsequent Massive Transfusion (MT) are associated with serious, often fatal complications including intractable Disseminated Intravascular Coagulation (DIC). Historically undesirable outcomes demonstrate the need to improve the management approach of MT. It is clear that evidence-based guidelines and protocols should be developed with the aim of improving MT-outcome. Methods:We implemented an evidence-based MT-Protocol (MTP) in 2007 and studied all patients (105) from Jan 2008 to Jan 2011 who required MT and were treated with the MTP at our institution. The MTP includes two phases and incorporates a fixed volume of Fresh Frozen Plasma (FFP), cryoprecipitate and platelets in addition to Packed Red Blood Cells (PRBC). Results:The median age of patients was 57 years (range, 18-86). The male to female ratio was 74:31. Median Hb was 90 g/L (range, 44-110) and platelet count was 190/nl (range, 34-817). Thirteen patients developed mild DIC; 22 moderate DIC and one severe DIC. D-dimer showed average increase of 7.9 mg/L with a range between 0.6-35 mg/L (Normal <0.5). Average INR was 1.97, (range, 1.2-7.2), while average APTT was 36 seconds (range, 22-88s). The mortality rate was 11.4% (12/105) and these were mainly related to underlying trauma rather than DIC with the exception of 1 patient. The average number of transfused PRBC was 15 units (range, 6-42); cryoprecipitate, 20(range, 10-60); platelets, 2(range, 1-7) and FFP, 8(range,[2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. Conclusion:Despite serious bleeding secondary to trauma or surgery, the implementation of MTP seems to have reduced the occurrence of severe DIC and was associated with a relatively low mortality-rate. Further studies to confirm these findings are warranted.

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Early and individualized goal-directed therapy for trauma-induced coagulopathy

Cited by 187 publications

References 93 publications

Prevention and treatment of trauma induced coagulopathy (TIC). An intended protocol from the Italian trauma update research group

Prevention and treatment of trauma induced coagulopathy (TIC). An intended protocol from the Italian trauma update research group

Survey of Poly Fibrinogen Levels in Patients With Major Blunt Trauma

Application of Massive Transfusion Protocol is Associated with a Low Incidence of Coagulopathy and Mortality Rate

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