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01.02.2015 | Original

Damage control resuscitation using blood component therapy in standard doses has a limited effect on coagulopathy during trauma hemorrhage

verfasst von: Sirat Khan, Ross Davenport, Imran Raza, Simon Glasgow, Henry D. De’Ath, Pär I. Johansson, Nicola Curry, Simon Stanworth, Christine Gaarder, Karim Brohi

Erschienen in: Intensive Care Medicine | Ausgabe 2/2015

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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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Holcomb JB, Del Junco DJ, Fox EE et al (2012) The prospective, observational, multicenter, major trauma transfusion (PROMMTT) study: comparative effectiveness of a time-varying treatment with competing risks. Arch Surg 15:1–10

Holcomb JB, Jenkins D, Rhee P et al (2007) Damage control resuscitation: directly addressing the early coagulopathy of trauma. J Trauma 62(2):307–310PubMedCrossRef

Schöchl H, Maegele M, Solomon C et al (2012) Early and individualized goal-directed therapy for trauma-induced coagulopathy. Scand J Trauma Resusc Emerg Med 20(1):15PubMedCentralPubMedCrossRef

Zink KA, Sambasivan CN, Holcomb JB et al (2009) A high ratio of plasma and platelets to packed red blood cells in the first 6 hours of massive transfusion improves outcomes in a large multicenter study. Am J Surg 197(5):565–570PubMedCrossRef

Borgman MA, Spinella PC, Perkins JG et al (2007) The ratio of blood products transfused affects mortality in patients receiving massive transfusions at a combat support hospital. J Trauma 63(4):805–813PubMedCrossRef

Morrison JJ, Ross JD, Poon H et al (2013) Intra-operative correction of acidosis, coagulopathy and hypothermia in combat casualties with severe haemorrhagic shock. Anaesthesia 68:846–850PubMedCrossRef

Davenport R, Curry N, Manson J et al (2011) Hemostatic effects of fresh frozen plasma may be maximal at red cell ratios of 1:2. J Trauma Acute Care Surg 70(1):90–96CrossRef

Snyder CW, Weinberg JA, McGwin G Jr et al (2009) The relationship of blood product ratio to mortality: survival benefit or survival bias? J Trauma 66:358–362PubMedCrossRef

Geeraedts LM Jr, Demiral H, Schaap NP et al (2007) ‘Blind’ transfusion of blood products in exsanguinating trauma patients. Resuscitation 73:382–388PubMedCrossRef

10.

Cotton BA, Reddy N, Hatch QM et al (2011) Damage control resuscitation is associated with a reduction in resuscitation volumes and improvement in survival in 390 damage control laparotomy patients. Ann Surg 254(4):598–605PubMedCrossRef

11.

Rourke C, Curry N, Khan S et al (2012) Fibrinogen levels during trauma hemorrhage, response to replacement therapy, and association with patient outcomes. J Thromb Haemost 10(7):1342–1351PubMedCrossRef

12.

Khan S, Brohi K, Chana M et al (2014) Hemostatic resuscitation is neither hemostatic nor resuscitative in trauma hemorrhage. J Trauma Acute Care Surg 76(3):561–568PubMedCrossRef

13.

NHSBT,UK Average Standardised Doses

14.

Ganter MT, Hofer CK (2008) Coagulation monitoring: current techniques and clinical use of viscoelastic point-of-care coagulation devices. Anesth Analg 106:1366–1375PubMedCrossRef

15.

Davenport R, Manson J, De’Ath H et al (2011) Functional definition and characterization of acute traumatic coagulopathy. Crit Care Med 39(12):2652–2658PubMedCentralPubMed

16.

Frith D, Goslings JC, Gaarder C et al (2011) Definition and drivers of acute traumatic coagulopathy: clinical and experimental investigations. J Thromb Haemost 8(9):1919–1925CrossRef

17.

Baker SP, O’Neill B, Haddon W Jr et al (1974) The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma 14(3):187–196PubMedCrossRef

18.

Holcomb J, Del Junco D, Fox E et al (2013) Resuscitation strategies in trauma. JAMA 309(21):2270–2271CrossRef

19.

Holcomb J (2014) Pragmatic randomized optimal platelets and plasma ratios (PROPPR). Injury 45(9):1287–1295PubMedCrossRef

Titel: Damage control resuscitation using blood component therapy in standard doses has a limited effect on coagulopathy during trauma hemorrhage
verfasst von: Sirat Khan
Ross Davenport
Imran Raza
Simon Glasgow
Henry D. De’Ath
Pär I. Johansson
Nicola Curry
Simon Stanworth
Christine Gaarder
Karim Brohi
Publikationsdatum: 01.02.2015
Verlag: Springer Berlin Heidelberg
Erschienen in: Intensive Care Medicine / Ausgabe 2/2015
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-014-3584-1

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Damage control resuscitation using blood component therapy in standard doses has a limited effect on coagulopathy during trauma hemorrhage