Transfusion in trauma: thromboelastometry-guided coagulation factor concentrate-based therapy versus standard fresh frozen plasma-based therapy
1 Ludwig Boltzmann Institute of Experimental and Clinical Traumatology, Donaueschingenstrasse 13, A-1200 Vienna, Austria
2 Department of Anaesthesiology and Intensive Care, AUVA Trauma Centre, Dr. Franz-Rehrl-Platz 5, 5010 Salzburg, Austria
3 Institute for Research in Operative Medicine, University of Witten/Herdecke, Cologne-Merheim Medical Center, Ostmerheimer Strasse 200, 51109 Cologne, Germany
4 Department of Trauma and Orthopedic Surgery, University of Witten/Herdecke, Cologne-Merheim Medical Centre, Ostmerheimer Strasse 200, 51109 Cologne, Germany
5 Department of Commercial Operations Western Europe, CSL Behring UK, Hayworth House, Market Place, Haywards Heath, RH16 1DB, UK
6 Department of Anaesthesiology and Intensive Care, Salzburger Landeskliniken SALK, Müllner Hauptstrasse 48, A-5020 Salzburg, Austria
7 Department of Anaesthesiology and Intensive Care, University Hospital Marburg, Baldingerstrasse, 35033 Marburg, Germany
8 Department of Anaesthesiology and Intensive Care, Hannover Medical School, Carl-Neuberg Strasse 1, 30625 Hannover, Germany
Critical Care 2011, 15:R83 doi:10.1186/cc10078
See related letter by David et al., http://ccforum.com/content/15/3/433Published: 4 March 2011
Thromboelastometry (TEM)-guided haemostatic therapy with fibrinogen concentrate and prothrombin complex concentrate (PCC) in trauma patients may reduce the need for transfusion of red blood cells (RBC) or platelet concentrate, compared with fresh frozen plasma (FFP)-based haemostatic therapy.
This retrospective analysis compared patients from the Salzburg Trauma Centre (Salzburg, Austria) treated with fibrinogen concentrate and/or PCC, but no FFP (fibrinogen-PCC group, n = 80), and patients from the TraumaRegister DGU receiving ≥ 2 units of FFP, but no fibrinogen concentrate/PCC (FFP group, n = 601). Inclusion criteria were: age 18-70 years, base deficit at admission ≥2 mmol/L, injury severity score (ISS) ≥16, abbreviated injury scale for thorax and/or abdomen and/or extremity ≥3, and for head/neck < 5.
For haemostatic therapy in the emergency room and during surgery, the FFP group (ISS 35.5 ± 10.5) received a median of 6 units of FFP (range: 2, 51), while the fibrinogen-PCC group (ISS 35.2 ± 12.5) received medians of 6 g of fibrinogen concentrate (range: 0, 15) and 1200 U of PCC (range: 0, 6600). RBC transfusion was avoided in 29% of patients in the fibrinogen-PCC group compared with only 3% in the FFP group (P< 0.001). Transfusion of platelet concentrate was avoided in 91% of patients in the fibrinogen-PCC group, compared with 56% in the FFP group (P< 0.001). Mortality was comparable between groups: 7.5% in the fibrinogen-PCC group and 10.0% in the FFP group (P = 0.69).
TEM-guided haemostatic therapy with fibrinogen concentrate and PCC reduced the exposure of trauma patients to allogeneic blood products.