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Damage control resuscitation using blood component therapy in standard doses has a limited effect on coagulopathy during trauma hemorrhage

机译:使用标准剂量的血液成分疗法进行损伤控制复苏对创伤性出血期间的凝血病影响有限

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Objective: To determine the effectiveness of blood component therapy in the correction of trauma-induced coagulopathy during hemorrhage. Background: Severe hemorrhage remains a leading cause of mortality in trauma. Damage control resuscitation strategies target trauma-induced coagulopathy (TIC) with the early delivery of high-dose blood components such as fresh frozen plasma (FFP) and platelet transfusions. However, the ability of these products to correct TIC during hemorrhage and resuscitation is unknown. Methods: This was an international prospective cohort study of bleeding trauma patients at three major trauma centers. A blood sample was drawn immediately on arrival and after 4, 8 and 12 packed red blood cell (PRBC) transfusions. FFP, platelet and cryoprecipitate use was recorded during these intervals. Samples were analyzed for functional coagulation and procoagulant factor levels. Results: One hundred six patients who received at least four PRBC units were included. Thirty-four patients (32 %) required a massive transfusion. On admission 40 % of patients were coagulopathic (ROTEM CA5 <= 35 mm). This increased to 58 % after four PRBCs and 81 % after eight PRBCs. On average all functional coagulation parameters and procoagulant factor concentrations deteriorated during hemorrhage. There was no clear benefit to highdose FFP therapy in any parameter. Only combined high-dose FFP, cryoprecipitate and platelet therapy with a high total fibrinogen load appeared to produce a consistent improvement in coagulation. Conclusions: Damage control resuscitation with standard doses of blood components did not consistently correct trauma-induced coagulopathy during hemorrhage. There is an important opportunity to improve TIC management during damage control resuscitation.
机译:目的:确定血液成分疗法在纠正出血引起的创伤性凝血病中的有效性。背景:严重出血仍然是造成创伤死亡的主要原因。损伤控制复苏策略以大剂量血液成分(如新鲜冰冻血浆(FFP)和血小板输注)的早期递送为目标,针对创伤引起的凝血病(TIC)。但是,这些产品在出血和复苏中纠正TIC的能力尚不清楚。方法:这是一项国际前瞻性队列研究,研究了三个主要创伤中心的出血患者。到达后立即输血,并在输注4、8和12包红细胞(PRBC)后立即抽取血液。在这些间隔期间记录了FFP,血小板和冷沉淀的使用。分析样品的功能性凝血和促凝血因子水平。结果:包括至少接受了4个PRBC病房的106名患者。三十四名患者(32%)需要大量输血。入院时有40%的患者患有凝血病(ROTEM CA5 <= 35 mm)。四个PRBC后增加到58%,八个PRBC之后增加到81%。平均而言,出血期间所有功能性凝血参数和促凝血因子浓度均下降。在任何参数下,大剂量FFP治疗均无明显益处。只有高剂量的FFP,冷沉淀和血小板疗法联合使用具有较高的总纤维蛋白原负荷时,才能产生持续的凝血改善。结论:用标准剂量的血液成分进行损伤控制复苏并不能始终如一地纠正出血引起的创伤性凝血病。在损害控制复苏期间,有一个重要的机会可以改善TIC管理。

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