Centre for Trauma Sciences, Blizard Institute, Barts and the London School of Medicine, Queen Mary University of London, London, UK,
Intensive Care Med. 2015 Feb;41(2):239-47. doi: 10.1007/s00134-014-3584-1. Epub 2014 Dec 2.
To determine the effectiveness of blood component therapy in the correction of trauma-induced coagulopathy during hemorrhage.
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.
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.
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 high-dose 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.
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.
确定在出血期间纠正创伤诱导的凝血障碍（TIC）时血液成分治疗的效果。
严重出血仍然是创伤导致死亡的主要原因。损伤控制性复苏策略的目标是创伤诱导的凝血障碍（TIC），通过早期给予高剂量的血液成分，如新鲜冷冻血浆（FFP）和血小板输注。然而，这些产品在出血和复苏期间纠正 TIC 的能力尚不清楚。
这是在三个主要创伤中心对出血性创伤患者进行的国际前瞻性队列研究。在到达时和输注 4、8 和 12 个单位浓缩红细胞（PRBC）后立即抽取血液样本。在这些时间间隔内记录 FFP、血小板和冷沉淀的使用情况。分析样本的功能凝血和促凝因子水平。
共纳入 106 名至少接受 4 个单位 PRBC 的患者。34 名患者（32%）需要大量输血。入院时，40%的患者凝血功能障碍（ROTEM CA5≤35mm）。输注 4 个 PRBC 后增加到 58%，输注 8 个 PRBC 后增加到 81%。平均而言，所有功能凝血参数和促凝因子浓度在出血期间都恶化。高剂量 FFP 治疗在任何参数上都没有明显的获益。只有高剂量 FFP、冷沉淀和血小板联合治疗，以及高总纤维蛋白原负荷，似乎才能持续改善凝血。
使用标准剂量的血液成分进行损伤控制性复苏并不能持续纠正出血期间的创伤诱导的凝血障碍。在损伤控制性复苏期间，有一个改善 TIC 管理的重要机会。
