Fibrinogen is a key predictor of whether the patient will go on to have a PPH Dr Erin Chamberlin & Dr Surbhi Malhotra Director of Anaesthetics & Perioperative Medicine
A great talk by Mr Ross Davenport, consultant Trauma and Vascular surgeon at the Royal London Hospital and Senior Investigator at the Centre for Trauma Sciences, discusses the pathophysiology of coagulopathy following trauma/ shock induced major haemorrhage. Talk ranges over current state of knowledge about causes, changes in treatments over time and evidence base for their effectiveness. https://vimeo.com/221457033
New #TraumaTalks video! Prof Tim Harris on #trauma shock early resuscitation https://vimeo.com/233807929 @JoMShepherd @RTallach @TraumaMasters
Rotational thromboelastometry significantly optimizes transfusion practices for damage control resuscitation in combat casualties.
Our hypothesis was that incorporating ROTEM measurements into DCR methods at the US Role 3 hospital at Bagram Airfield, Afghanistan would change the standard transfusion ratios of 1:1:1:1 to a product mix tailored specifically for the combat causality. The introduction of ROTEM significantly improved adherence to DCR practices. The transfusion differences suggest that aggressive DCR without thromboelastometry data may result in reduced hemostatic support
Congratulations to Bronwyn Pearse at the Prince Charles Hospital In Queensland winner of grant funding for her work in Patient Blood Management and Critical Bleeding.
Thromboelastometry (ROTEM®) is an advancement of the classical thromboelastography. Several technical enhancements made the device more robust and user-friendly, reduced intra- and inter-operator variability, and improved the diagnostic performance. This allows for using the device at the bedside in a mobile way and in a multiuser environment, even in military settings. The ROTEM® device is not only able to detect multiple aspects of trauma-induced coagulopathy (TIC) and disseminated intravascular coagulation (DIC), but it allows for prediction of bleeding, massive transfusion, thrombosis, and mortality, too. Furthermore, the ROTEM® device is designed to guide hemostatic therapy with allogeneic blood products (RBC, FFP, cryoprecipitate, and platelets) and in particular with specific coagulation factor concentrates (fibrinogen concentrate, prothrombin complex concentrate (PCC), factor XIII concentrate, and rFVIIa). Here, the combination of specific ROTEM® assays improved the diagnostic performance, significantly. Finally, the implementation of ROTEM®-guided bleeding management algorithms (“Theragnostic Approach”) has been shown to reduce transfusion requirements, complication rates, morbidity, mortality, and hospital costs in trauma and other clinical settings.
FEISTY – Fibrinogen Early In Severe Trauma study.Is it quicker to administer Fibrinogen concentrate than cryoprecipitate?
Lay SummaryOver 7000 Australians are treated for severe trauma every year. Major bleeding in the setting of trauma is associated with poor outcomes and increased rates of death. Severe trauma causes a decrease in the factors within the blood that helps clots to form and stop bleeding. This loss of clotting factors is associated with worse outcomes and it is proposed that early replacement of these factors may reduce bleeding and improve outcomes.
Fibrinogen is one of the key clotting factors that needs to be replaced in severe traumatic bleeding.
Fibrinogen concentrate (FC) is an alternative product used to assist in blood clotting. It is stored in powder form, can be reconstituted at the bedside and given quickly. The study will investigate whether it is quicker to administer FC than cryoprecipitate, which will reduce haemorrhage and improve outcomes. For more information see the link here
A systematic review on the rotational thrombelastometry (ROTEM®) values for the diagnosis of coagulopathy, prediction and guidance of blood transfusion and prediction of mortality in trauma patients
Overall, specific ROTEM® parameters measured (clot amplitude and lysis) in the extrinsically activated test (EXTEM) and the fibrin-based extrinsically activated test (FIBTEM) were consistently associated with the diagnosis of coagulopathy, increased risk of bleeding and massive transfusion, and prediction of mortality. Presence of hyperfibrinolysis by ROTEM® was associated with increased mortality.
Violeta is based in the Hunter Valley NSW