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Low hemorrhage‐related mortality in trauma patients in a L evel I trauma center employing transfusion packages and early thromboelastography‐directed hemostatic resuscitation with plasma and platelets
Author(s) -
Johansson Pär I.,
Sørensen Anne Marie,
Larsen Claus F.,
Windeløv Nis A.,
Stensballe Jakob,
Perner Anders,
Rasmussen Lars S.,
Ostrowski Sisse R.
Publication year - 2013
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1111/trf.12214
Subject(s) - medicine , thromboelastography , trauma center , resuscitation , injury severity score , platelet , blood transfusion , transfusion therapy , fresh frozen plasma , hemostasis , anesthesia , packed red blood cells , blood product , blunt trauma , surgery , emergency medicine , poison control , retrospective cohort study , injury prevention
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 L evel I trauma center. Demography, I njury S everity S core ( 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.