Olaussen Alexander, Fitzgerald Mark C, Tan Gim A, Mitra Biswadev
aDepartment of Community Emergency Health and Paramedic Practice, Monash UniversitybTrauma Service, The Alfred HospitalcNational Trauma Research Institute, The Alfred HospitaldEmergency & Trauma Centre, The Alfred HospitaleDepartment of Medicine, Monash UniversityfDepartment of Epidemiology & Preventive Medicine, Monash University, Victoria, Australia.
Eur J Emerg Med. 2016 Aug;23(4):269-273. doi: 10.1097/MEJ.0000000000000259.
Haemorrhage remains among the most preventable causes of trauma death. Massive transfusion protocols, as part of 'haemostatic resuscitation', have been implemented in most trauma centres. Relative to the attention to the ideal ratio of red blood cells to fresh frozen plasma and platelets, cryoprecipitate treatment has been infrequently discussed. We aimed to outline the use of cryoprecipitate during trauma resuscitation and analyse outcomes in patients who received cryoprecipitate after hypofibrinogenaemia detection.
A retrospective review of registry data on all major trauma patients (Injury Severity Score>15) presenting to a level I trauma centre over a 4-year period (2008-2011) was conducted. We selected all patients who had received cryoprecipitate and then analysed patients who had received cryoprecipitate following the detection of hypofibrinogenaemia (<1.0 g/l). Mortality at hospital discharge among hypofibrinogenaemic patients who had received cryoprecipitate was compared with that among patients who had not received cryoprecipitate.
Of 3996 trauma patients, 3571 had fibrinogen levels recorded. Most patients (n=3517, 98.5%) had initial fibrinogen counts of 1.0 g/l or higher, and cryoprecipitate was administered to a small proportion of these patients (n=126, 3.6%). Of the 54 patients with hypofibrinogenaemia on arrival, one patient died immediately and was excluded from further analysis. Of the 53 patients, 30 received cryoprecipitate and 28/53 died (53%). There was no difference in mortality between those who had received and those who had not received cryoprecipitate (14/30 vs. 14/23, P=0.31).
Administration of cryoprecipitate was uncommon during trauma resuscitation, even among patients with hypofibrinogenaemia on presentation. This study provides no evidence towards improved outcomes from administration of cryoprecipitate.
出血仍是创伤死亡最可预防的原因之一。大多数创伤中心已实施大量输血方案，作为“止血复苏”的一部分。相对于对红细胞与新鲜冰冻血浆及血小板理想比例的关注，冷沉淀治疗很少被讨论。我们旨在概述创伤复苏期间冷沉淀的使用情况，并分析在检测到纤维蛋白原血症后接受冷沉淀治疗的患者的结局。
对一家一级创伤中心在4年期间（2008 - 2011年）收治的所有主要创伤患者（损伤严重度评分>15）的登记数据进行回顾性分析。我们选取了所有接受过冷沉淀治疗的患者，然后分析在检测到纤维蛋白原血症（<1.0 g/l）后接受冷沉淀治疗的患者。将接受冷沉淀治疗的纤维蛋白原血症患者的出院死亡率与未接受冷沉淀治疗的患者进行比较。
在3996例创伤患者中，3571例记录了纤维蛋白原水平。大多数患者（n = 3517，98.5%）初始纤维蛋白原计数为1.0 g/l或更高，这些患者中一小部分（n = 126，3.6%）接受了冷沉淀治疗。在入院时纤维蛋白原血症的54例患者中，1例患者立即死亡并被排除在进一步分析之外。在53例患者中，30例接受了冷沉淀治疗，28/53例死亡（53%）。接受冷沉淀治疗和未接受冷沉淀治疗的患者死亡率无差异（14/30对14/23，P = 0.31）。
在创伤复苏期间，冷沉淀的使用并不常见，即使在入院时患有纤维蛋白原血症的患者中也是如此。本研究没有提供证据表明冷沉淀治疗能改善结局。
