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Introduction of an algorithm for ROTEM ‐guided fibrinogen concentrate administration in major obstetric haemorrhage
Author(s) -
Mallaiah S.,
Barclay P.,
Harrod I.,
Chevannes C.,
Bhalla A.
Publication year - 2015
Publication title -
anaesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.839
H-Index - 117
eISSN - 1365-2044
pISSN - 0003-2409
DOI - 10.1111/anae.12859
Subject(s) - fibrinogen , medicine , shock (circulatory) , coagulation , anesthesia , prospective cohort study , coagulation testing , surgery
Summary We compared blood component requirements during major obstetric haemorrhage, following the introduction of fibrinogen concentrate. A prospective study of transfusion requirements and patient outcomes was performed for 12 months to evaluate the major obstetric haemorrhage pathway using shock packs (Shock Pack phase). The study was repeated after the pathway was amended to include fibrinogen concentrate (Fibrinogen phase). The median (IQR [range]) number of blood components given was 8.0 (3.0–14.5 [0–32]) during the Shock Pack phase, and 3.0 (2.0–5.0 [0–26]) during the Fibrinogen phase (p = 0.0004). The median (IQR [range]) quantity of fibrinogen administered was significantly greater in the Shock Pack phase, 3.2 (0–7.1 [0–20.4]) g, than in the Fibrinogen phase, 0 (0–3.0 [0–12.4]) g, p = 0.0005. Four (9.5%) of 42 patients in the Shock Pack phase developed transfusion associated circulatory overload compared with none of 51 patients in the Fibrinogen phase (p = 0.038). Fibrinogen concentrate allows prompt correction of coagulation deficits associated with major obstetric haemorrhage, reducing the requirement for blood component therapy and the attendant risks of complications.