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Intensive Care Medicine
Published in: Intensive Care Medicine 2/2015

01-02-2015 | Original

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

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

Published in: Intensive Care Medicine | Issue 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.
Appendix
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Metadata
Title
Damage control resuscitation using blood component therapy in standard doses has a limited effect on coagulopathy during trauma hemorrhage
Authors
Sirat Khan
Ross Davenport
Imran Raza
Simon Glasgow
Henry D. De’Ath
Pär I. Johansson
Nicola Curry
Simon Stanworth
Christine Gaarder
Karim Brohi
Publication date
01-02-2015
Publisher
Springer Berlin Heidelberg
Published in
Intensive Care Medicine / Issue 2/2015
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-014-3584-1

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