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- Title
Low hemorrhage-related mortality in trauma patients in a Level I trauma center employing transfusion packages and early thromboelastography-directed hemostatic resuscitation with plasma and platelets.
- Authors
Johansson, Pär I.; Sørensen, Anne Marie; Larsen, Claus F.; Windeløv, Nis A.; Stensballe, Jakob; Perner, Anders; Rasmussen, Lars S.; Ostrowski, Sisse R.
- Abstract
Background Hemorrhage accounts for most preventable trauma deaths, but still the optimal strategy for hemostatic resuscitation remains debated. Study Design and Methods This was a prospective study of adult trauma patients admitted to a Level I trauma center. Demography, Injury Severity Score ( ISS), transfusion therapy, and mortality were registered. Hemostatic resuscitation was based on a massive transfusion protocol encompassing transfusion packages and thromboelastography ( TEG)-guided therapy. Results A total of 182 patients were included (75% males, median age 43 years, ISS of 17, 92% with blunt trauma). Overall 28-day mortality was 12% with causes of death being exsanguinations (14%), traumatic brain injury (72%, two-thirds expiring within 24 hr), and other (14%). One-fourth, 16 and 15% of the patients, received red blood cells (RBCs), plasma, or platelets (PLTs) within 2 hours from admission and 68, 71, and 75%, respectively, of patients transfused within 24 hours received the respective blood products within the first 2 hours. In patients transfused within 24 hours, the median number of blood products at 2 hours was 5 units of RBCs, 5 units of plasma, and 2 units of PLT concentrates. Nonsurvivors had lower clot strength by kaolin-activated TEG and TEG functional fibrinogen and lower kaolin-tissue factor-activated TEG α-angle and lysis after 30 minutes compared to survivors. None of the TEG variables were independent predictors of massive transfusion or mortality. Conclusion Three-fourths of the patients transfused with plasma or PLTs within 24 hours received these in the first 2 hours. Hemorrhage caused 14% of the deaths. We introduced transfusion packages and early TEG-directed hemostatic resuscitation at our hospital 10 years ago and this may have contributed to reducing hemorrhagic trauma deaths.
- Subjects
BLOOD transfusion; BLOOD coagulation tests; HEMORRHAGE prevention; RESUSCITATION; MORTALITY; BLOOD plasma; BLOOD platelets
- Publication
Transfusion, 2013, Vol 53, Issue 12, p3088
- ISSN
0041-1132
- Publication type
Article
- DOI
10.1111/trf.12214