Introduction of an algorithm for ROTEM-guided fibrinogen concentrate administration in major obstetric haemorrhage

Abstract

SummaryWe compared blood component requirements during major obstetric haemorrhage, following the introduction of fibrinogen concentrate. A prospective study of transfusion requirements and patient outcomes was performed for 12 months to evaluate the major obstetric haemorrhage pathway using shock packs (Shock Pack phase). The study was repeated after the pathway was amended to include fibrinogen concentrate (Fibrinogen phase).

A reply

“…We thank Dr Ralph for her interest in our work [1]. We have used intra-operative cell salvage during operative obstetric interventions since 2006, and as routine practice since 2010.…”

“…WO2014109659 A1). Positioning the load cell within the handle allows a disposable laryngoscope blade to be used [1]. Unlike previously used spot force sensors [1], the load cell response is linear, reproducible and measures the peak and total forces transmitted to the patient during laryngoscopy.…”

“…Positioning the load cell within the handle allows a disposable laryngoscope blade to be used [1]. Unlike previously used spot force sensors [1], the load cell response is linear, reproducible and measures the peak and total forces transmitted to the patient during laryngoscopy. These are transmitted wirelessly to a computer readout with an audible alarm, the sound frequency of which varies from 0 Hz with 0 N force detected by 100 Hz.N À1 .…”

“…We read with great interest the recent article by Shin et al [1] about the effects of acute normovolaemic haemodilution with hydroxyethyl starch (HES) 130/0.4 on peri-operative clotting. We suggest that the hypocoagulable state reported was not due to normovolaemic haemodilution as suggested, but rather their choice of HES as the replacement fluid.…”

Management of Postpartum Hemorrhage: Fibrinogen vs. Prothrombin Complex concentrate

“…Results of two studies in which thromboelastography was used for management of PPH showed that functional fibrinogen deficiency could worsen the outcome of major PPH (9,10). If fibrinogen therapy is guided by results of ROTEM (Rotational thromboelastography), it will lead to reduced requirements for blood components and lower risk of circulatory overload (11). European society of anesthesiologists recommended an initial fibrinogen concentrate dose of 20-25 mL/kg in plasma fibrinogen concentration of less than 1.5-2 g/L or thromboelastography signs of functional fibrinogen deficit (12).…”