Hemorrhage Clinical Trial
Official title:
Transfusion and Coagulation Management in Trauma Patients After the Introduction of a Coagulation Algorithm
Comparison of the consumption of blood and coagulation products (packed red blood cells, fresh frozen plasma, platelet concentrates, fibrinogen, coagulation factor concentrates, coagulation factor XIII, activated factor VII, van Willebrand factor and antifibrinolytics) before and after the introduction of a designated trauma related transfusion and coagulation algorithm.The periods 2005-2007 (before) and 2012-2014 (after) the introduction are reviewed. Two level-1 trauma centers in Switzerland (Hospital Lucerne, University Hospital Zurich) are included in the study. Predicted probability of a massive transfusion by the trauma associated acute hemorrhage score (TASH)is correlated with the actual rate.
Trauma is one of the leading causes of death worldwide. After death due to direct
craniofacial injury, exsanguination is the next major cause for trauma mortality.
After initial pre-hospital treatment the patient is admitted to the hospital. If multiple
injuries are present the patient is transferred to a specialized trauma center.
Besides surgical treatment, the patient needs stabilization of the vital functions by the
Anesthesiologist. Due to loss of blood volume, dilution of the circulatory blood volume and
pathological activation of coagulation/fibrinolysis, trauma induced coagulopathy (TIC) is
initiated. This needs to be treated and avoided whenever possible.
Transfusion of allogeneic blood and coagulation product itself leads to an increased
morbidity and mortality. Infectious and immunologic reactions account for that phenomenon.
This led to a paradigm change in the therapy of TIC. In 2009 a new coagulation factor based
coagulation algorithm was introduced in the Hospital Lucerne and the University Hospital in
Zurich / Switzerland. With the help of point of care coagulation measurement, tailored
coagulation factor based coagulation management and avoidance of allogeneic blood products
was initiated.
The investigators now want to analyze the impact of the coagulation algorithm by comparing
the periods before and after the introduction of the algorithm.
The consumption of blood and coagulation products (packed red blood cells, fresh frozen
plasma, platelet concentrates, fibrinogen, coagulation factor concentrates, coagulation
factor XIII, activated factor VII, van Willebrand factor and antifibrinolytics) before and
after the introduction of a designated trauma related transfusion and coagulation algorithm
will be recorded and compared. The periods 2005-2007 (before) and 2012-2014 (after) the
introduction are reviewed. Predicted probability of a massive transfusion by the TASH score
(trauma associated acute hemorrhage) is correlated with the actual rate.
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