Goal-directed therapy in trauma induced coagulopathy and focus on traumatic brain injury
DOI:
https://doi.org/10.7175/rhc.v4i3S.877Keywords:
Goal-directed therapy, Trauma induced coagulopathy (TIC), Traumatic brain injury (TBI), ROTEM®Abstract
In recent years there have been major advances in the management of trauma-induced coagulopathy (TIC) and many experiences have demonstrated how we can achieve significant improvements with multidisciplinary approach and implementation of standardized protocols and algorithms. Central nervous system injuries and exanguination remain the primary causes of early trauma-related mortality. Traumatic brain injuries (TBI) make hemostasis in TIC even more complex and it is known that the onset of coagulopathy in a patient with severe brain injury has a negative impact on the patient’s outcome in terms of mortality. Standard coagulation tests provide limited information on coagulation disorder. The advantages of whole-blood viscoelastic tests, such as rotational thromboelastometry or thrombelastography, are shorter turn-around time and better diagnostic performance compared to routine plasmatic coagulation tests. In contrast to a fixed ratio of FFP:PC:RBC, the aim of the goal-directed coagulation therapy is to set treatment to the actual needs of the individual patient, based on viscoelastic test results. This article describes the improvements achieved through the implementation of ROTEM-guided treatment algorithms for visceral surgery and liver trasplantation, severe trauma and post-partum hemorrhage and cardiovascular surgery.
References
Sauaia A, Moore FA, Moore EE, et al. Epidemiology of trauma deaths: a reassessment. J Trauma 1995; 38: 185-93; http://dx.doi.org/10.1097/00005373-199502000-00006
Wafaisade A, Lefering R, Tjardes T, et al; Trauma Registry of DGU. Acute coagulopathy in isolated blunt traumatic brain injury. Neurocrit Care 2010; 12: 211-9; http://dx.doi.org/10.1007/s12028-009-9281-1
Schöchl H, Solomon C, Traintinger S, et al. Thromboelastometric (ROTEM) findings in patients suffering from isolated severe traumatic brain injury. J Neurotrauma 2011; 28: 2033-41; http://dx.doi.org/10.1089/neu.2010.1744
Lustenberger T, Talving P, Kobayashi L, et al. Time course of coagulopathy in isolated severe traumatic brain injury. Injury 2010; 41: 924-8; http://dx.doi.org/10.1016/j.injury.2010.04.019
Laroche M, Kutcher ME, Huang MC, et al. Coagulopathy after traumatic brain injury. Neurosurgery 2012; 70: 1334-45; http://dx.doi.org/10.1227/NEU.0b013e31824d179b
Chan CM, Zilberberg MD. Preferences in traumatic intracranial hemorrhage: bleeding vs. clotting. Crit Care 2010; 14: 153; http://dx.doi.org/10.1186/cc8996
Kiphuth IC, Staykov D, Köhrmann M, et al. Early administration of low molecular weight heparin after spontaneous intracerebral hemorrhage. A safety analysis. Cerebrovasc Dis 2009; 27: 146-50; http://dx.doi.org/10.1159/000177923
Adamzik M, Eggmann M, Frey UH, et al. Comparison of thromboelastometry with procalcitonin, interleukin 6, and C-reactive protein as diagnostic tests for severe sepsis in critically ill adults. Crit Care 2010; 14: R178; http://dx.doi.org/10.1186/cc9284
Solomon C, Traintinger S, Ziegler B, et al. Platelet function following trauma. A multiple electrode aggregometry study. Thromb Haemost 2011; 106: 322-30; http://dx.doi.org/10.1160/TH11-03-0175
Davenport R, Manson J, De’Ath H, et al. Functional definition and characterization of acute traumatic coagulopathy. Crit Care Med 2011; 39: 2652-8
Schöchl H, Cotton B, Inaba K, et al. FIBTEM provides early prediction of massive transfusion in trauma. Crit Care 2011; 15: R265; http://dx.doi.org/10.1186/cc10539
Haas T, Spielmann N, Mauch J, et al. Comparison of thromboelastometry (ROTEM®) with standard plasmatic coagulation testing in paediatric surgery. Br J Anaesth 2012; 108: 36-41; http://dx.doi.org/10.1093/bja/aer342
Gonzalez EA, Moore FA, Holcomb JB, et al. Fresh frozen plasma should be given earlier to patients requiring massive transfusion. J Trauma 2007; 62: 112-9; http://dx.doi.org/10.1097/01.ta.0000250497.08101.8b
Bochicchio GV, Napolitano L, Joshi M, et al. Outcome analysis of blood product transfusion in trauma patients: a prospective, risk-adjusted study. World J Surg 2008; 32: 2185-9; http://dx.doi.org/10.1007/s00268-008-9655-0
Inaba K, Branco BC, Rhee P, et al. Impact of ABO-identical vs ABO-compatible nonidentical plasma transfusion in trauma patients. Arch Surg 2010; 145: 899-906; http://dx.doi.org/10.1001/archsurg.2010.175
Shanwell A, Andersson TM, Rostgaard K, et al. Post-transfusion mortality among recipients of ABO-compatible but non-identical plasma. Vox Sang 2009; 96: 316-23; http://dx.doi.org/10.1111/j.1423-0410.2009.01167.x
Khan H, Belsher J, Yilmaz M, et al. Fresh-frozen plasma and platelet transfusions are associated with development of acute lung injury in critically ill medical patients. Chest 2007; 131: 1308-14; http://dx.doi.org/10.1378/chest.06-3048
Waydhas C, Görlinger K. Coagulation management in multiple trauma. Unfallchirurg 2009; 112: 942-50; http://dx.doi.org/10.1007/s00113-009-1681-3
Görlinger K, Fries D, Dirkmann D, et al. Reduction of Fresh Frozen Plasma Requirements by Perioperative Point-of-Care Coagulation Management with Early Calculated Goal-Directed Therapy. Transfus Med Hemother 2012; 39: 104-113; http://dx.doi.org/10.1159/000337186
Schöchl H, Nienaber U, Maegele M, et al. Transfusion in trauma: thromboelastometry-guided coagulation factor concentrate-based therapy versus standard fresh frozen plasma-based therapy. Crit Care 2011; 15: R83; http://dx.doi.org/10.1186/cc10078
Holcomb JB. Traditional transfusion practices are changing. Crit Care 2010; 14: 162; http://dx.doi.org/10.1186/cc9009
Görlinger K, Dirkmann D, Hanke AA, et al. First-line therapy with coagulation factor concentrates combined with point-of-care coagulation testing is associated with decreased allogeneic blood transfusion in cardiovascular surgery: a retrospective, single-center cohort study. Anesthesiology 2011; 115: 1179-91
Weber CF, Görlinger K, Meininger D, et al. Point-of-care testing: a prospective, randomized clinical trial of efficacy in coagulopathic cardiac surgery patients. Anesthesiology 2012; 117: 531-47; http://dx.doi.org/10.1097/ALN.0b013e318264c644
Published
Issue
Section
License
Authors who publish with this journal agree to the following terms:- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution-NonCommercial 4.0 License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal. The Publication Agreement can be downloaded here, and should be signed by the Authors and sent to the Publisher when the article has been accepted for publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).
- Authors are permitted to post their work online after publication (the article must link to publisher version, in html format)
