Background
Methods
Study design and participants
Setting
Transfusion and coagulation algorithm
Basics of both algorithm
Main differences between both algorithm
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For the RBC transfusion management, a target haematocrit-range of 0.21–0.24 is specified in USZ-Alg, whereas in LUKS-Alg only a lower haematocrit limit of 0.21 is defined.
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LUKS-Alg contains the option for selected Trauma patients (age < 50 years, no fatal injury, temperature > 35 °C and diffuse bleeding) to administer the following transfusion - and coagulation package blindly and not goal-directed: 2 g Tranexamic acid, 4 g Fibrinogen, 1′000 U Prothrombin complex concentrate, 4 RBCs (blood group 0 negative) and 1250 U factor XIII.
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In the LUKS-Alg, Factor XIII 1250 U (15 U/kg) is considered if FIBTEM maximum clot firmness stays ≤ 7 mm despite fibrinogen administration, or factor XIII activity is < 60%. According to the USZ-Alg Factor XIII may be administering blindly after 6 g of fibrinogen or at factor XIII activity < 60% to improve clot stabilization.
Variables and data collection
Endpoints and outcome variables
Statistical analyses
USZ (n = 172) | LUKS (n = 172) | Standardized difference | |
---|---|---|---|
Age (years) | 53.6 (21.8) | 51.1 (19.7) | 0.09 |
Sex (male) | 119 (69%) | 121 (70%) | 0.03 |
Heart rate (bpm) on admission | 90 (23) (n = 169) | 91 (21) (n = 167) | 0.04 |
Systolic blood pressure (mmHg) on admission | 131 (27) (n = 171) | 132 (31) (n = 168) | 0.04 |
Penetrating trauma | 8 (5%) | 6 (4%) (n = 169) | 0.06 |
GCS on scene | 13 [6;15] (n = 167) | 13 [6;15] (n = 169) | 0.09 |
ISS | 27.8 (14.5) | 27.9 (11.5) | 0.01 |
Time (min.) prehospital | 65 [55;84] | 70 [55;90] (n = 143) | 0.01# |
Time (min.) ED | 145 [100;255] | 170 [105;309] (n = 143) | 0.11# |
Prehospital intubation | 48 (28%) | 56 (33%) | 0.10 |
Vasopressor use (in the ED) | 90 (52%) | 93 (54%) | 0.03 |
First laboratory values determined after admission to the ED | |||
Haemoglobin (g/dl) | 12.1 (2.1) (n = 166) | 12.1 (2.3) (n = 169) | 0.00 |
Platelet count (G/l) | 186 [152;225] (n = 167) | 197 [164;227] (n = 164) | 0.10# |
Base Excess (mmol/l) | −3.5 (4.9) (n = 165) | −2.8 (5.5) (n = 165) | 0.12 |
Lactate (mmol/l) | 1.7 [1.1;2.6] (n = 166) | 1.7 [1.0;3.0] (n = 148) | 0.13# |
Quick’s value (%) | 71 (22) (n = 167) | 73 (19) (n = 166) | 0.09 |
Fibrinogen (g/l) | 2.3 (1.0) (n = 160) | 2.3 (0.8) (n = 162) | 0.07 |
Results
Usage of blood products, coagulations factors and resuscitation fluids
USZ (n = 172) | LUKS (n = 172) | OR (95% CI) | p-value | |
---|---|---|---|---|
RBC | 20 (11.6%) | 51 (29.7%) | 3.2 (1.8–5.7) | < 0.001 |
FFP | 4 (2.3%) | 9 (5.2%) | 2.3 (0.7–7.7) | 0.16 |
PLT | 10 (5.8%) | 6 (3.5%) | 0.6 (0.2–1.6) | 0.31 |
TXA | 76 (44.2%) | 66 (28.6%) | 0.8 (0.5–1.2) | 0.29 |
Fibrinogen | 42 (24.4%) | 59 (34.3%) | 1.6 (1.0–2.6) | 0.04 |
PCC | 17 (9.9%) | 41 (23.8%) | 2.9 (1.5–5.3) | 0.001 |
Factor XIII | 15 (8.7%) | 6 (3.5%) | 0.4 (0.1–1.0) | 0.04 |
Starch | 5 (2.9%) | 37 (21.5%) | 9.2 (3.5–23.9) | < 0.001 |
Gelatin | 47 (27.3%) | 27 (15.7%) | 0.5 (0.3–0.8) | 0.009 |
USZ (n = 172) | LUKS (n = 172) | p-value | |
---|---|---|---|
RBC (U) | 0.5 (1.9) | 1.5 (3.9) | < 0.001 |
FFP (U) | 0.1 (0.6) | 0.4 (2.2) | 0.15 |
PLT (U) | 0.1 (0.3) | 0.1 (0.4) | 0.32 |
FFP:RBC (ratio) | 0.1 (0.3) | 0.1 (0.3) | 0.91 |
Fibrinogen (g) | 1.1 (2.6) | 1.5 (3.0) | 0.05 |
PCC (IU) | 124 (408) | 454 (1011) | < 0.001 |
Factor XIII (IU) | 116 (388) | 51 (282) | 0.04 |
Crystalloid (ml) | 2130 (2642) | 3944 (4064) | < 0.001 |
Starch (ml) | 13 (94) | 146 (319) | < 0.001 |
Gelatin (ml) | 347 (722) | 142 (392) | 0.004 |