Perioperative treatment algorithm for bleeding burn patients reduces allogeneic blood product requirements

Abstract

The significant reduction in allogeneic blood product requirements during surgical burn wound excision is a prospective proof of concept that a bleeding management algorithm based on thromboelastometry is efficacious. Hypofibrinogenaemia and hyperfibrinolysis are not significant pathomechanisms of bleeding in this setting and ROTEM(®) helps to avoid unnecessary interventions.

The Effects of In Vitro Hemodilution and Fibrinogen Concentrate Substitution on Thromboelastometry Analysis in Patients Qualified for Liver Transplantation – Preliminary Results

“…This negative effect depends on dilution level and diluter type. Such results were reported by others authors [2,3,5]. In our study MCF reduction with blood dilution was statistically significant in both groups and it was accompanied by similar alteration of A10 FIBTEM.…”

“…Thromboelastometry is one of the methods of assessment of clot formation dynamics and quality in whole blood [2]. This method is more effective than standard laboratory tests in diagnosing fibrinogen deficiency, polymerisation disorders and management of goal-directed hemostatic therapy [3]. prothrombin complex concentrate (PCC), activated recombinant factor VII (rVIIa), and factor XIII have been investigated in combinations among various diluters and dilutions [4e7].…”

The use of viscoelastic haemostatic assays in goal-directing treatment with allogeneic blood products – A systematic review and meta-analysis

“…This left 15 RCTs with a total of n  = 1238 patients to be included in this analysis. Of these trials, 9 referred to cardiothoracic patients [28–36] and one each to liver transplantation [37], surgical excision of burn wounds [38], trauma [22], cirrhotic patients [39], scoliosis surgery [40] and post-partum haemorrhage [41]. In twelve studies the intervention group was guided by TEG [22, 28, 29, 31–35, 37, 39–41] and in the remaining three by ROTEM [30, 36, 38].…”

“…Of these trials, 9 referred to cardiothoracic patients [28–36] and one each to liver transplantation [37], surgical excision of burn wounds [38], trauma [22], cirrhotic patients [39], scoliosis surgery [40] and post-partum haemorrhage [41]. In twelve studies the intervention group was guided by TEG [22, 28, 29, 31–35, 37, 39–41] and in the remaining three by ROTEM [30, 36, 38]. Seven trials applied both results from CCTs and the discretion of the attending physician to guide the transfusions of the control group [28, 31, 32, 35, 38, 40, 41], while the control groups of eight trials were guided only by CCTs [22, 29, 30, 33, 34, 36, 37, 39] with the first transfused blood products being guided solely at the clinician’s discretion before blood analyses were available in two trials [22, 30].…”

Impact of Early Thromboelastography-Directed Therapy in Trauma Resuscitation

“…The 2016 European guidelines on management of major bleeding and coagulopathy following trauma encourages restriction in volume replacement during resuscitation and guidance by goaldirected strategies [10]. Several authors advocate the use of visco-elastic tests to guide and reduce blood product requirements during resuscitation by transfusing on the basis of specific component requirements [19,[22][23][24]. In a recent single-center, parallel-group, open-label, randomized trial, the use of fibrinogen supplementation for severe clotting failure in multiple trauma demonstrated superiority over FFP [25].…”