Ionised calcium levels in major trauma patients who received blood in the Emergency Department

Webster, Stacey; Todd, Stephanie; Redhead, Julian; Wright, Chris

doi:10.1136/emermed-2015-205096

Cited by 42 publications

(41 citation statements)

References 10 publications

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“…This compares favourably with the study by Webster et al ,7 who provided evidence of a similar mean calcium level following transfusion in the ED (mean 0.95 mmol/L).…”

Section: Discussionsupporting

confidence: 85%

“…This supports the findings of previous in-hospital studies that have demonstrated that blood product administration reduces calcium levels 6 7. These studies disagree on the cut-off point with Giancarelli et al advocating that over 5 units of blood is needed to produce a clinically relevant reduction,6 while others argue that even 1 unit of blood reduces calcium levels below the accepted normal value, consistent with our findings 7…”

Section: Discussionsupporting

confidence: 69%

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Ionised calcium levels in major trauma patients who received blood en route to a military medical treatment facility

et al. 2017

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“…This compares favourably with the study by Webster et al ,7 who provided evidence of a similar mean calcium level following transfusion in the ED (mean 0.95 mmol/L).…”

Section: Discussionsupporting

confidence: 85%

Section: Discussionsupporting

confidence: 69%

Ionised calcium levels in major trauma patients who received blood en route to a military medical treatment facility

et al. 2017

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“…Additionally, current massive transfusion protocols dictate transfusion of high ratios of FFP [29] which has also been independently associated with hypocalcaemia [10, 30,31]. We therefore hypothesize that patients with admission ionized hypocalcaemia as observed in this study are likely to become more severely hypocalcaemic during haemostatic resuscitation [25,26].…”

Section: Discussionmentioning

confidence: 82%

“…Hypocalcaemia was associated with early death mirroring the pattern of death observed in the setting of acute traumatic coagulopathy [23,24]. Early resuscitative measures involving blood transfusion are also likely to further exacerbate hypocalcaemia [25,26].…”

Section: Discussionmentioning

confidence: 88%

Hypocalcaemia and traumatic coagulopathy: an observational analysis

et al. 2019

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Background and Objectives Haemorrhage‐associated calcium loss may lead to disruption of platelet function, intrinsic and extrinsic pathway‐mediated haemostasis and cardiac contractility. Among shocked major trauma patients, we aimed to investigate the association between admission hypocalcaemia and adverse outcomes. Materials and Methods Data were extracted from the Alfred Trauma Registry and the Alfred Applications and Knowledge Management Department for all adult major trauma patients presenting directly from the scene with a shock index ≥1 from 1 July 2014 to 30 June 2018. Patients with pre‐hospital blood transfusion were excluded. Ionized hypocalcaemia was defined as <1·11 mmol/l, and acute traumatic coagulopathy was defined as initial INR >1·5. Multivariable logistic regression analysis was used to assess the association between admission hypocalcaemia and acute traumatic coagulopathy that was adjusted for Injury Severity Score, initial GCS, bicarbonate and lactate. Results There were 226 patients included in final analysis with 113 (50%) patients recording ionized hypocalcaemia on presentation prior to any blood product transfusion. Ionized hypocalcaemia was associated with coagulopathy in patients with shock index ≥1 (adjusted OR 2·9; 95% CI: 1·01–8·3, P = 0·048). Admission ionized hypocalcaemia was also associated with blood transfusion requirement in the first 24 h post‐admission in 62·5% of hypocalcaemic patients as compared to 37·5% of normocalcaemic patients (P < 0·001). Admission ionized hypocalcaemia was associated with death at hospital discharge (25·6% among hypocalcaemic patients compared to 15·0% of normocalcaemic patients (P = 0·047)). Conclusion Hypocalcaemia was a common finding in shocked trauma patients and was independently associated with acute traumatic coagulopathy. The early, protocolized administration of calcium to trauma patients in haemorrhagic shock warrants further assessment in randomized controlled trials.

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“…This could be related to the knowledge that while calcium is an important cofactor to several physiological components of haemostasis, hypocalcemia in acute bleeding is common, and treatment with ABT may worsen this with chelation by citrate additive. 70 It remains that calcium supplementation an important principle of bleeding management with a grade 1B recommendation " calcium should be administered during massive transfusion if calcium concentration is low, to preserve normocalaemia (>0.9 mmol/l)". 14…”

Section: Various Guidelines Including the Society Of Thoracic Surgeonmentioning

confidence: 99%

<p>Bleeding Management Practices of Australian Cardiac Surgeons, Anesthesiologists and Perfusionists: A Cross-Sectional National Survey Incorporating the Theoretical Domains Framework (TDF) and COM-B Model</p>

Pearse

Keogh

Rickard

et al. 2020

JMDH

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Purpose: Excessive bleeding is an acknowledged consequence of cardiac surgery, occurring in up to 10% of adult patients. This clinically important complication leads to poorer patient outcomes. Clinical practice guidelines are available to support best practice however variability in bleeding management practice and related adverse outcomes still exist. This study had two objectives: 1) to gain insight into current bleeding management practice for adult cardiac surgery in Australia and how that compared to guidelines and literature; and 2) to understand perceived difficulties clinicians face implementing improvements in bleeding management. Methods: A national cross-sectional questionnaire survey was utilized. Perspectives were sought from cardiac surgeons, cardiac anesthesiologists and perfusionists. Thirty-nine closedended questions focused on routine bleeding management practices to address pre and intraoperative care. One open-ended question was asked; "What would assist you to improve bleeding management with cardiac surgery patients?" Quantitative data were analysed with SPSS. Qualitative data were categorized into the domains of the Theoretical Domains Framework; the domains were then mapped to the COM-B model. Results: Survey responses from 159 Anesthesiologists, 39 cardiac surgeons and 86 perfusionists were included (response rate 37%). Four of the recommendations queried in this survey were reported as routinely adhered to < 50% of the time, 9 queried recommendations were adhered to 51-75% of the time and 4 recommendations were routinely followed >76% of the time. Conclusion: There is a wide variation in peri-operative bleeding management practice among cardiac anaesthesiologists, surgeons and perfusionists in Australian cardiac surgery units. Conceptualizing factors believed necessary to improve practice with the TDF and COM-B model found that bleeding management could be improved with a standardized approach including; point of care diagnostic assays, a bleeding management algorithm, access to concentrated coagulation factors, cardiac surgery specific bleeding management education, multidisciplinary team agreement and support, and an overarching national approach.

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Ionised calcium levels in major trauma patients who received blood in the Emergency Department

Abstract: Trauma patients that have sustained blood loss are at risk of hypocalcaemia. Ionised calcium levels fall significantly further even after receiving a small amount of blood product. Prompt recognition and early targeted treatment is needed from arrival.

Cited by 42 publications

References 10 publications

Ionised calcium levels in major trauma patients who received blood en route to a military medical treatment facility

Ionised calcium levels in major trauma patients who received blood en route to a military medical treatment facility

Hypocalcaemia and traumatic coagulopathy: an observational analysis

<p>Bleeding Management Practices of Australian Cardiac Surgeons, Anesthesiologists and Perfusionists: A Cross-Sectional National Survey Incorporating the Theoretical Domains Framework (TDF) and COM-B Model</p>

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