Goal-directed coagulation management of major trauma patients using thromboelastometry (ROTEM®)-guided administration of fibrinogen concentrate and prothrombin complex concentrate
By H. Schöchl, U. Nienaber, Georg Hofer, W. Voelckel, C. Jámbor, G. Scharbert, S. Kozek‐Langenecker, C. Solomon. Critical Care, 2010
654 citations recorded by the source corpus.
IntroductionThe appropriate strategy for trauma-induced coagulopathy management is under debate. We report the treatment of major trauma using mainly coagulation factor concentrates.MethodsThis retrospective analysis included trauma patients who received ≥ 5 units of red blood cell concentrate within 24 hours. Coagulation management was guided by thromboelastometry (ROTEM®). Fibrinogen concentrate was given as first-line haemostatic therapy when maximum clot firmness (MCF) measured by FibTEM (fibrin-based test) was <10 mm. Prothrombin complex concentrate (PCC) was given in case of recent coumarin intake or clotting time measured by extrinsic activation test (EXTEM) >1.5 times normal. Lack of improvement in EXTEM MCF after fibrinogen concentrate administration was an indication for platelet concentrate. The observed mortality was compared with the mortality predicted by the trauma injury severity score (TRISS) and by the revised injury severity classification (RISC) score.ResultsOf 131 patients included, 128 received fibrinogen concentrate as first-line therapy, 98 additionally received PCC, while 3 patients with recent coumarin intake received only PCC. Twelve patients received FFP and 29 received platelet concentrate. The observed mortality was 24.4%, lower than the TRISS mortality of 33.7% (P = 0.032) and the RISC mortality of 28.7% (P > 0.05). After excluding 17 patients with traumatic brain injury, the difference in mortality was 14% observed versus 27.8% predicted by TRISS (P = 0.0018) and 24.3% predicted by RISC (P = 0.014).ConclusionsROTEM®-guided haemostatic therapy, with fibrinogen concentrate as first-line haemostatic therapy and additional PCC, was goal-directed and fast. A favourable survival rate was observed. Prospective, randomized trials to investigate this therapeutic alternative further appear warranted.
Subfields: Critical Care and Intensive Care Medicine, Hematology, Pulmonary and Respiratory Medicine
View Paper: https://www.semanticscholar.org/paper/a8e5f722c6cff6945fb738a1fe849c93c1570279
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In Critical Care and Intensive Care Medicine
In Hematology
In Pulmonary and Respiratory Medicine
Citations in the corpus
- The European guideline on management of major bleeding and coagulopathy following trauma: fourth edition (2016, background): “Early therapeutic intervention does improve coagulation tests [375], reduce the need for transfusion of RBC, FFP and platelets [12, 376], reduce the incidence of post-traumatic multi-organ failure, shorten length of hospital stay [12] and may improve survival [377, 378].”
- The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition (2019, methodology): “should PCC be administered to normalise the EXTEM clotting time [516, 614].”
- Management of bleeding and coagulopathy following major trauma: an updated European guideline (2013, background): “mortality when compared to expected mortality [317],”