Goal-directed transfusion protocol via thrombelastography in patients with abdominal trauma: a retrospective study

Abstract

IntroductionThe optimal transfusion protocol remains unknown in the trauma setting. This retrospective cohort study aimed to determine if goal-directed transfusion protocol based on standard thrombelastography (TEG) is feasible and beneficial in patients with abdominal trauma.MethodsSixty adult patients with abdominal trauma who received 2 or more units of red blood cell transfusion within 24 hours of admission were studied. Patients managed with goal-directed transfusion protocol via TEG (goal-directed group) were compared to patients admitted before utilization of the protocol (control group).ResultsThere were 29 patients in the goal-directed group and 31 in the control group. Baseline parameters were similar except for higher admission systolic blood pressure in the goal-directed group than the control group (121.8 ± 23.1 mmHg vs 102.7 ± 26.5 mmHg, p < 0.01). At 24 h, patients in the goal-directed group had shorter aPTT compared to patients in the control group (39.2 ± 16.3 s vs 58.6 ± 36.6 s, p = 0.044). Administration of total blood products at 24 h appeared to be fewer in the goal-directed group than the control group (10.2 [7.0-43.1]U vs 14.8 [8.3-37.6]U, p = 0.28), but this was not statistically significant. Subgroup analysis including patients with ISS ≥16 showed that patients in the goal-directed group had significantly fewer consumption of total blood products than patients in the control group (7[6.1, 47.0]U vs 37.6[14.5, 89.9]U, p = 0.015). No differences were found in mortality at 28d, length of stay in intensive care unit and hospital between the two groups.ConclusionsGoal-directed transfusion protocol via standard TEG was achievable in patients with abdominal trauma. The novel protocol, compared to conventional transfusion management, has the potential to decrease blood product utilization and prevent exacerbation of coagulation function.

Fixed ratio versus goal-directed therapy in trauma

“…No differences between groups in ICU and hospital length of stay or 28-day mortality were observed [89].…”

“…Yin et al [89] investigated the effect of GDCT in adult patients with abdominal trauma who received at least 2 U RBCs within 24 h. In a subgroup of patients with injury severity score at least 16, GDCT significantly reduced transfusion of blood products compared with the control group (7 U versus 37.6 U, P ¼ 0.015). No differences between groups in ICU and hospital length of stay or 28-day mortality were observed [89].…”

“…Until now, only a few small retrospective studies and some case reports have been published using GDCT [7,[9][10][11]85,[87][88][89].…”

Can the Viscoelastic Parameter α-Angle Distinguish Fibrinogen from Platelet Deficiency and Guide Fibrinogen Supplementation?

“…5 Despite the fact that various newer TEG® assays have recently been released, 6,7 the kaolin-activated assay (later described as TEG® mono-analysis) alone is often used to guide hemostatic therapy in many institutions, [8][9][10][11][12] even though it has been occasionally noted that a mono-analysis approach cannot distinguish platelet from fibrin/fibrinogen deficiency. 5,13 Therefore, when therapies for fibrinogen supplementation are available (therapeutic plasma, cryoprecipitate, or fibrinogen concentrate), there is a likelihood that fibrin-/ fibrinogen-deficient patients would not receive the most appropriate therapy if decision making is based on TEG® mono-analysis alone.…”

Monitoring the coagulation status of trauma patients with viscoelastic devices

“…On the other hand, Yin et al [40] reported a goaldirected transfusion protocol based on the results of TEG® in patients with abdominal trauma in Nanjing Hospital, China, in 2014. If the R value that represents the time to early clot formation was prolonged, fresh frozen plasma was administered and its dose was decided according to the degree of prolongation.…”