Abstract
Objective
To determine the effectiveness of blood component therapy in the correction of trauma-induced coagulopathy during hemorrhage.
Background
Severe hemorrhage remains a leading cause of mortality in trauma. Damage control resuscitation strategies target trauma-induced coagulopathy (TIC) with the early delivery of high-dose blood components such as fresh frozen plasma (FFP) and platelet transfusions. However, the ability of these products to correct TIC during hemorrhage and resuscitation is unknown.
Methods
This was an international prospective cohort study of bleeding trauma patients at three major trauma centers. A blood sample was drawn immediately on arrival and after 4, 8 and 12 packed red blood cell (PRBC) transfusions. FFP, platelet and cryoprecipitate use was recorded during these intervals. Samples were analyzed for functional coagulation and procoagulant factor levels.
Results
One hundred six patients who received at least four PRBC units were included. Thirty-four patients (32 %) required a massive transfusion. On admission 40 % of patients were coagulopathic (ROTEM CA5 ≤ 35 mm). This increased to 58 % after four PRBCs and 81 % after eight PRBCs. On average all functional coagulation parameters and procoagulant factor concentrations deteriorated during hemorrhage. There was no clear benefit to high-dose FFP therapy in any parameter. Only combined high-dose FFP, cryoprecipitate and platelet therapy with a high total fibrinogen load appeared to produce a consistent improvement in coagulation.
Conclusions
Damage control resuscitation with standard doses of blood components did not consistently correct trauma-induced coagulopathy during hemorrhage. There is an important opportunity to improve TIC management during damage control resuscitation.
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Acknowledgments
Funded in part by the National Institute for Health Research (UK) Program Grant for Applied Research (RP-PG-0407-10036).
Conflicts of interest
TEM Innovations (ROTEM): unrestricted support in the form of equipment and reagents for the ACIT study. SK and RD have received honoraria as invited speakers.
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Take home message: Severe hemorrhage remains a leading cause of mortality in trauma despite improvements in our understanding of trauma-induced coagulopathy. Our findings from an international prospective cohort study of severely injured bleeding trauma patients at three major trauma centers indicate that damage control resuscitation with standard doses of blood components does not consistently correct trauma-induced coagulopathy during hemorrhage.
On behalf of the International Trauma Research Network (INTRN).
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Khan, S., Davenport, R., Raza, I. et al. Damage control resuscitation using blood component therapy in standard doses has a limited effect on coagulopathy during trauma hemorrhage. Intensive Care Med 41, 239–247 (2015). https://doi.org/10.1007/s00134-014-3584-1
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DOI: https://doi.org/10.1007/s00134-014-3584-1