1561: MORTALITY FOLLOWING HIGH BLOOD PRODUCT TRANSFUSION AMONG SEVERELY INJURED TRAUMA PATIENTS

AbstractIntroductionHemorrhage remains the major cause of preventable death after trauma. Recent data suggest that earlier blood product administration may improve outcomes. The purpose of this study was to determine whether opportunities exist for blood product transfusion by ground Emergency Medical Services (EMS).MethodsThis was a single EMS agency retrospective study of ground and helicopter responses from January 1, 2011 through December 31, 2015 for adult trauma patients transported from the scene of injury who met predetermined hemodynamic (HD) parameters for potential transfusion (heart rate [HR]≥120 and/or systolic blood pressure [SBP]≤90).ResultsA total of 7,900 scene trauma ground transports occurred during the study period. Of 420 patients meeting HD criteria for transfusion, 53 (12.6%) had a significant mechanism of injury (MOI). Outcome data were available for 51 patients; 17 received blood products during their emergency department (ED) resuscitation. The percentage of patients receiving blood products based upon HD criteria ranged from 1.0% (HR) to 5.9% (SBP) to 38.1% (HR+SBP). In all, 74 Helicopter EMS (HEMS) transports met HD criteria for blood transfusion, of which, 28 patients received prehospital blood transfusion. Statistically significant total patient care time differences were noted for both the HR and the SBP cohorts, with HEMS having longer time intervals; no statistically significant difference in mean total patient care time was noted in the HR+SBP cohort.ConclusionsIn this study population, HD parameters alone did not predict need for ED blood product administration. Despite longer transport times, only one-third of HEMS patients meeting HD criteria for blood administration received prehospital transfusion. While one-third of ground Advanced Life Support (ALS) transport patients manifesting HD compromise received blood products in the ED, this represented 0.2% of total trauma transports over the study period. Given complex logistical issues involved in prehospital blood product administration, opportunities for ground administration appear limited within the described system.MixFM, ZielinskiMD, MyersLA, BernsKS, LukeA, StubbsJR, ZietlowSP, JenkinsDH, SztajnkrycerMD. Prehospital blood product administration opportunities in ground transport ALS EMS – a descriptive study. Prehosp Disaster Med. 2018;33(3):230–236.

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Outcome Analysis of Blood Product Transfusion in Trauma Patients: A Prospective, Risk-Adjusted Study

World Journal of Surgery ◽

10.1007/s00268-008-9655-0 ◽

2008 ◽

Vol 32 (10) ◽

Cited By ~ 66

Author(s):

Grant V. Bochicchio ◽

Lena Napolitano ◽

Manjari Joshi ◽

Kelly Bochicchio ◽

Walter Meyer ◽

...

Keyword(s):

Blood Product ◽

Outcome Analysis ◽

Blood Product Transfusion ◽

Trauma Patients ◽

Prospective Risk

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A retrospective cohort analysis of ionised calcium levels in major trauma patients who have received early blood product transfusion in the Emergency Department

Scandinavian Journal of Trauma Resuscitation and Emergency Medicine ◽

10.1186/1757-7241-23-s2-o3 ◽

2015 ◽

Vol 23 (S2) ◽

Author(s):

Stacey J Webster ◽

Samuel JH Todd ◽

Chris R Wright

Keyword(s):

Emergency Department ◽

Retrospective Cohort ◽

Major Trauma ◽

Blood Product ◽

Cohort Analysis ◽

Blood Product Transfusion ◽

Trauma Patients ◽

Retrospective Cohort Analysis ◽

Ionised Calcium

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Fibrinogen Early In Severe Trauma studY (FEISTY): results from an Australian multicentre randomised controlled pilot trial

Critical Care and Resuscitation ◽

10.51893/2021.1.oa3 ◽

2021 ◽

Vol 23 (1) ◽

pp. 32-46

Author(s):

James Winearls ◽

◽

Martin Wullschleger ◽

Elizabeth Wake ◽

Zoe McQuilten ◽

...

Keyword(s):

Critical Role ◽

Pilot Trial ◽

Severe Trauma ◽

Major Haemorrhage ◽

Blood Product Transfusion ◽

Trauma Patients ◽

Severely Injured ◽

Optimal Method ◽

Transfusion Requirements ◽

Randomised Controlled

BACKGROUND: Haemorrhage is a major cause of death in severe trauma. Fibrinogen plays a critical role in maintaining haemostasis in traumatic haemorrhage, and early replacement using fibrinogen concentrate (FC) or cryoprecipitate (Cryo) is recommended by several international trauma guidelines. Limited evidence supports one product over the other, with widespread geographic and institutional variation in practice. Two previous trials have investigated the feasibility of rapid FC administration in severely injured trauma patients, with conflicting results. OBJECTIVE: To compare the time to fibrinogen replacement using FC or Cryo in severely injured trauma patients with major haemorrhage and hypofibrinogenaemia. DESIGN, SETTING, PATIENTS AND INTERVENTIONS: A multicentre controlled pilot trial in which adult trauma patients with haemorrhage were randomly assigned (1:1) to receive FC or Cryo for fibrinogen replacement, guided by FIBTEM A5 (functional fibrinogen assessment at 5 minutes after clot formation, using rotational thromboelastometry). MAIN OUTCOME MEASURES: The primary outcome was time to commencement of fibrinogen replacement. Secondary outcomes included effects of the intervention on plasma fibrinogen levels and clinical outcomes including transfusion requirements and mortality. RESULTS: Of the 100 randomly assigned patients, 62 were hypofibrinogenaemic and received the intervention (n = 37) or Cryo (n = 25). Median (interquartile range [IQR]) time to delivery of FC was 29 min (23–40 min) compared with 60 min (40–80 min) for Cryo (P = 0.0001). All 62 patients were hypofibrinogenaemic before receiving FC or Cryo (FC: median FIBTEM A5, 8 mm [IQR, 7–9 mm]; Cryo: median FIBTEM A5, 9 mm [IQR, 5–10 mm]). In the FC arm patients received a median of 3 g FC (IQR, 2–4 g), and in the Cryo arm patients received a median of 8 units of Cryo (IQR, 8–14 units). Restoration of fibrinogen levels was achieved in both arms after the intervention. Blood product transfusion, fluid resuscitation and thromboembolic complications were similar in both arms. Overall mortality was 15.3%, with more deaths in the FC arm. CONCLUSION: Fibrinogen replacement in severely injured trauma patients with major haemorrhage and hypofibrinogenaemia was achieved substantially faster using FC compared with Cryo. Fibrinogen levels increased appropriately using either product. The optimal method for replacing fibrinogen in traumatic haemorrhage is controversial. Our results will inform the design of a larger trial powered to assess patient-centred outcomes.

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Blood Product Transfusion and Ventilator-Associated Pneumonia in Trauma Patients

Surgical Infections ◽

10.1089/sur.2006.069 ◽

2008 ◽

Vol 9 (4) ◽

pp. 415-422 ◽

Cited By ~ 40

Author(s):

Grant V. Bochicchio ◽

Lena Napolitano ◽

Manjari Joshi ◽

Kelly Bochicchio ◽

Diane Shih ◽

...

Keyword(s):

Blood Product ◽

Blood Product Transfusion ◽

Trauma Patients ◽

Ventilator Associated Pneumonia

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The impact of blood product ratio and procoagulant therapy on the development of thromboembolic events in severely injured hemorrhaging trauma patients

Transfusion ◽

10.1111/trf.15917 ◽

2020 ◽

Vol 60 (8) ◽

pp. 1873-1882

Author(s):

Mathijs R. Wirtz ◽

Daisy V. Schalkers ◽

J. Carel Goslings ◽

Nicole P. Juffermans

Keyword(s):

Blood Product ◽

Trauma Patients ◽

Severely Injured ◽

Thromboembolic Events ◽

Product Ratio ◽

The Impact

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What's new for trauma haemorrhage management?

British Journal of Hospital Medicine ◽

10.12968/hmed.2019.80.5.268 ◽

2019 ◽

Vol 80 (5) ◽

pp. 268-273

Author(s):

Paul Vulliamy ◽

Anthony J Thaventhiran ◽

Ross A Davenport

Keyword(s):

Blood Product ◽

Global Burden ◽

Blood Product Transfusion ◽

Trauma Patients ◽

Major Contributor ◽

Early Administration ◽

Haemorrhage Control ◽

Treatment Priority ◽

Active Research ◽

Radiological Intervention

Uncontrolled haemorrhage is the leading cause of preventable death from injury and is a major contributor to the global burden of disease. The majority of deaths resulting from bleeding occur within the first 3 hours of hospital admission, and the window for meaningful intervention is therefore extremely small. Resuscitative efforts during active bleeding should focus on maintaining haemostatic function with blood product transfusion and early administration of tranexamic acid. Achieving control of haemorrhage is the overarching treatment priority and may require temporising measures before definitive surgical or radiological intervention. This review summarizes the contemporary approaches to resuscitation of bleeding trauma patients, options for achieving haemorrhage control, and current areas of active research including organ protective resuscitation and suspended animation.

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Point-of-Care Coagulation Monitoring in Trauma Patients

Seminars in Thrombosis and Hemostasis ◽

10.1055/s-0037-1598062 ◽

2017 ◽

Vol 43 (04) ◽

pp. 367-374 ◽

Cited By ~ 18

Author(s):

Philipp Stein ◽

Alexander Kaserer ◽

Gabriela Spahn ◽

Donat Spahn

Keyword(s):

Blood Product ◽

Point Of Care ◽

Fixed Ratio ◽

Allogeneic Blood ◽

Blood Product Transfusion ◽

Trauma Patients ◽

Coagulation Management ◽

Trauma Induced Coagulopathy ◽

Trauma Patient Outcome ◽

Factor Concentrate

AbstractTrauma remains one of the major causes of death and disability all over the world. Uncontrolled blood loss and trauma-induced coagulopathy represent preventable causes of trauma-related morbidity and mortality. Treatment may consist of allogeneic blood product transfusion at a fixed ratio or in an individualized goal-directed way based on point-of-care (POC) and routine laboratory measurements. Viscoelastic POC measurement of the developing clot in whole blood and POC platelet function testing allow rapid and tailored coagulation and transfusion treatment based on goal-directed, factor concentrate–based algorithms. The first studies have been published showing that this concept reduces the need for allogeneic blood transfusion and improves outcome. This review highlights the concept of goal-directed POC coagulation management in trauma patients, introduces a selection of POC devices, and presents algorithms which allow a reduction in allogeneic blood product transfusion and an improvement of trauma patient outcome.

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