Clinical and cellular effects of hypothermia, acidosis and coagulopathy in major injury

Thorsen, Kenneth; Ringdal, Kjetil Gorseth; Strand, Kristian; Søreide, Eldar; Hagemo, Jostein S.; Søreide, Kjetil

doi:10.1002/bjs.7497

Cited by 90 publications

(49 citation statements)

References 130 publications

(201 reference statements)

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“…Vasoconstriction is due not only to the injury itself but also to what is known as the lethal triad-an intricately connected combination of hypothermia, acidosis, and coagulopathy commonly associated with trauma ( Figure 2). 16 Hypothermia-associated coagulopathy occurs when core temperature decreases to less than 33°C (91.4°F). Reprinted from Thorsen et al, 16 with permission.…”

Section: Pathophysiology Of Trauma and Associated Hemorrhagementioning

confidence: 99%

“…16 Hypothermia-associated coagulopathy occurs when core temperature decreases to less than 33°C (91.4°F). Reprinted from Thorsen et al, 16 with permission. (defined as prothrombin time > 14 seconds and partial thromboplastin time > 34 seconds) was an independent predictor of mortality in patients with major trauma, increasing their risk of death by 35%.…”

Section: Pathophysiology Of Trauma and Associated Hemorrhagementioning

confidence: 99%

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Consequences of Transfusing Blood Components in Patients With Trauma: A Conceptual Model

Jones

Frazier

2017

Critical Care Nurse

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Transfusion of blood components is often required in resuscitation of patients with major trauma. Packed red blood cells and platelets break down and undergo chemical changes during storage (known as the storage lesion) that lead to an inflammatory response once the blood components are transfused to patients. Although some evidence supports a detrimental association between transfusion and a patient’s outcome, the mechanisms connecting transfusion of stored components to outcomes remain unclear. The purpose of this review is to provide critical care nurses with a conceptual model to facilitate understanding of the relationship between the storage lesion and patients’ outcomes after trauma; outcomes related to trauma, hemorrhage, and blood component transfusion are grouped according to those occurring in the short-term (≤30 days) and the long-term (>30 days). Complete understanding of these clinical implications is critical for practitioners in evaluating and treating patients given transfusions after traumatic injury.

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Section: Pathophysiology Of Trauma and Associated Hemorrhagementioning

confidence: 99%

Section: Pathophysiology Of Trauma and Associated Hemorrhagementioning

confidence: 99%

Consequences of Transfusing Blood Components in Patients With Trauma: A Conceptual Model

Jones

Frazier

2017

Critical Care Nurse

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“…In vivo animal models [5] and clinical studies [6] demonstrated an association between coagulopathy and hypothermia. Laboratory studies show that decreased temperature inhibits platelet function [7,8] and the activity of enzymes involved in the co-…”

Section: Introductionmentioning

confidence: 99%

Too Cold to Clot? Does Intraoperative Hypothermia Contribute to Bleeding Following Aortic Surgery?

Stein¹,

Rubinfeld²,

Balsam³

et al. 2017

aorta

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Background: We determined the impact of intraoperative hypothermia on postoperative bleeding after thoracic aortic surgery. Methods: We retrospectively analyzed 98 consecutive patients who underwent aortic surgery with deep hypothermic circulatory arrest between 2010 and 2014. We evaluated lowest temperature, absolute decrease in temperature, and rewarming rate. Univariate and multivariate regression were used to determine relationships between temperature, clinical characteristics, and measures of postoperative bleeding. Results: The mean age of patients was 60.5 ± 15.1 years, with 64.3% male and 60% Caucasian. The lowest temperatures recorded were 13.5 ± 4.6°C at the bypass circuit. Change in hematocrit was associated with ethnicity, preoperative hematocrit, and rewarming rate. Chest tube output was associated with body mass index, preoperative platelet count, prior cardiac surgery, cardiopulmonary bypass (CPB) duration, intraoperative blood product transfusion, lowest surface temperature, and change in surface temperature. Postoperative packed red blood cell transfusion was associated with ejection fraction, chronic obstructive pulmonary disease (COPD), platelet count, partial thromboplastin time, CPB duration, and lowest blood temperature. Fresh frozen plasma transfusion correlated with COPD, CPB duration, and final blood temperature. Platelet transfusion correlated with body mass index and preoperative platelet count. Unplanned reoperation for bleeding was associated with final temperature and change in temperature. Conclusion: We found no consistent associations between intraoperative temperature and indicators of bleeding. Intraoperative cooling strategies should be based on optimal end-organ protection rather than fear of postoperative bleeding; rewarming strategies may ameliorate the risk of coagulopathy.

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“…It can be caused by the loss of coagulation factors due to haemorrhage, hypothermia, acidosis, trauma and dilution from the intravenous fluids (IVF) administration [3][4][5]. The circulatory system can be viewed as an electrical circuit (P= F x R) in which P represents pressure difference between the two ends of the vessel, F is blood flow and R is called the vascular resistance [6].…”

Section: Introductionmentioning

confidence: 99%

Impact of crystalloids and colloids on coagulation cascade during trauma resuscitation-a literature review

Kaczynski¹,

Wilczynska²,

Hilton³

et al. 2013

Emerg Med Health Care

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Background: During resuscitation trauma patients receive various intravenous fluids, which can exacerbate coagulopathy and haemorrhage further. This led to the introduction of the damage control resuscitation, which advocates minimal intravenous fluids use. However, some fluid may be required in uncontrolled haemorrhage or when blood products are not immediately available. Furthermore, questions regarding the type and volume of the administered fluids remain still unanswered. Methods: Review of literature. Results: Crystalloids such as 0.9% Isotonic Saline and Lactate Ringers can cause either a hypercoagulable (lower dilutions) or hypocoagulable (higher dilutions) derangements. Hypertonic Saline (7.5%) leads to more pronounced coagulation abnormalities when compared with 0.9% Isotonic Saline. The effects of the 7.5% Hypertonic Saline combined with 6 % Dextran 70 are controversial. Some authors reported significant clotting abnormalities, but others found an improvement in the haemodynamic parameters. The evidence on human albumin solution use in trauma is very limited and suggests a procoagulant effect at lower dilutions. Gelofusine even with smaller volumes leads to pronounced coagulation abnormalities. All Dextrans (40 and 70) cause significant hypocoagulability at lower dilutions. Similarly lower molecular starches demonstrate a definite hypocoagulable effect. Conclusions: A literature review has also indicated that none of the studies demonstrated survival or outcome benefit associated with a particular type and volume of administered intravenous fluids. The results are controversial and further research is needed to clarify this issue.

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Clinical and cellular effects of hypothermia, acidosis and coagulopathy in major injury

Abstract: The triad of hypothermia, acidosis and coagulopathy after severe trauma appears to be fairly rare but does carry a poor prognosis. Future research should define modes of early detection and targeted therapy.

Cited by 90 publications

References 130 publications

Consequences of Transfusing Blood Components in Patients With Trauma: A Conceptual Model

Consequences of Transfusing Blood Components in Patients With Trauma: A Conceptual Model

Too Cold to Clot? Does Intraoperative Hypothermia Contribute to Bleeding Following Aortic Surgery?

Impact of crystalloids and colloids on coagulation cascade during trauma resuscitation-a literature review

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