Blood Component Therapy in Trauma Haemorrhage
Publisher
Metadata
Show full item recordAbstract
Exsanguination following severe injury remains the most common preventable cause of
traumatic death. One third of these patients exhibit trauma-induced coagulopathy (TIC)
with an associated significant morbidity and mortality. A key feature of damage control
resuscitation (DCR) is early diagnosis and direct targeting of TIC with blood component
therapy combined in major haemorrhage protocols (MHPs). The impact and efficacy of
high-dose blood component therapy on TIC is currently unknown. The overall aim of this
thesis is to address these specific areas of uncertainty.
A prospective observational cohort study of 106 severely injured, bleeding trauma patients
was performed over a three-year period. Blood samples for coagulation testing and clotting
factor analysis were drawn on arrival and during the acute bleeding (resuscitative) phase
after administration of every 4 U of PRBCs, up to 12 U. The quantity of blood products
administered within each interval was recorded.
Following implementation of MHP significantly higher ratios of blood component therapy
were observed. FFP:PRBC transfusion improved from 1:3 to 1:2 (p<0.01) and
CRYO:PRBCs from 1:10 to 1:7 (p<0.05). There was a six-fold reduction in platelets
wastage (14% to 2%, p<0.01). On admission, 43% of patients were coagulopathic and
increased to 49% by PRBC 4, 62% by PRBC 8 and 68% by PRBC 12, despite adherence to
DCR strategies. In shock, lactate clearance did not occur until haemorrhage control was
achieved with no further PRBC requirement. Only the combination of high-dose FFP,
CRYO and platelet therapy with a high total fibrinogen load produced a consistent
improvement in ROTEM parameters.
4
The body of work within this thesis supports the need for larger studies to determine the
clinical benefits of early fibrinogen supplementation in treating severely injured trauma
patients suffering from life threatening haemorrhage.
Authors
Khan, Sirat Z.Collections
- Theses [3930]