Cesena experience in the management of trauma induced coagulopathy: where are we going?

摘要

In recent years the management of the Trauma Center has witnessed the implementation of a significant change in the approach to critical bleeding and acute trauma-induced coagulopathy. The Trauma Center of “Bufalini” Hospital in Cesena has achieved a leading position in this system, especially with a multidisciplinary approach that has strongly influenced the organization of the Trauma Center. Thus, it is of particular interest the involvement of specialists in Transfusion Medicine within the Trauma Center: “Bufalini” Hospital was among the first in Italy to bring hematologists from Transfusion Medicine Department in the Trauma Team. This approach, which has led to very significant improvements in the way we manage polytrauma patients, is now spreading widely in other national centers. In 2009 the first Massive Transfusion Protocol (MTP) was implemented in the Trauma Center, with the aim of identifying patients at risk, improving the communication between different healthcare professionals and achieving a blood components fixed ratio. Transfusion support was part of the context of the Damage Control Resuscitation (DCR) based on the principles of permissive hypotension, Damage Control Surgery (DCS) and Haemostatic Resuscitation. Considering the major medical and scientific knowledge and new data available, in 2011 the “Bufalini” Hospital Working Group modified its MTP with the aim of obtaining a rapid diagnosis of hyperfibrinolisis, an early diagnosis of hypofibrinogenemia and reduce therapy with blood components. It has also been developed an algorithm for the proper interpretation of Point-Of-Care Device results (ROTEM?).