Gerinnungsmanagement beim kreislaufinstabilen Polytraumapatienten

Hilbert, P.; Go, Hofmann; K, zur Nieden; Teichmann, J; Jakubetz, J.; Stuttmann, R.

doi:10.1007/s00101-012-2064-7

Cited by 9 publications

(4 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Data from the literature and our own data show a good correlation between the initial hemoglobin value and clotting parameters, such as thromboplastin time (Quick value) (5-7, 9-11). For this reason and in the absence of point-of-care diagnostics (POCs) such as ROTEM ® in the SR, we have developed a hemoglobin-driven algorithm (described below) to guide the initial coagulation therapy.…”

Section: Methodssupporting

confidence: 59%

“…Therefore, it seems reasonable to use the initial hemoglobin value (as a quickly available parameter) to determine the initial clotting therapy for a bleeding, hemodynamically unstable patient. The results obtained from our trauma patients showed a clear correlation between the initial hemoglobin value and the Quick value (5, 6). Although the “European guideline for management of bleeding following major trauma” (8) does not recommend using Hct, which corresponds with hemoglobin, as a marker for bleeding, we developed the described hemoglobin-driven algorithm for the purposes of initiating early and aggressive clotting therapy.…”

Section: Discussionmentioning

confidence: 60%

“…One parameter that is quickly available in the resuscitation room is the hemoglobin level. If a multiple trauma patient has already received fluid resuscitation, a certain relationship can be observed between the hemoglobin value and the development of clotting disorders (5-7). …”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The “Coagulation Box” and a New Hemoglobin-Driven Algorithm for Bleeding Control in Patients With Severe Multiple Traumas

et al. 2013

View full text Add to dashboard Cite

BackgroundExtensive hemorrhage is the leading cause of death in the first few hours following multiple traumas. Therefore, early and aggressive treatment of clotting disorders could reduce mortality. Unfortunately, the availability of results from commonly performed blood coagulation studies are often delayed whereas hemoglobin (Hb) levels are quickly available.ObjectivesIn this study, we evaluated the use of initial hemoglobin (Hb) levels as a guide line for the initial treatment of clotting disorders in multiple trauma patients.Patients and MethodsWe have developed an Hb-driven algorithm to initiate the initial clotting therapy. The algorithm contains three different steps for aggressive clotting therapy depending on the first Hb value measured in the shock trauma room, (SR) and utilizes fibrinogen, prothrombin complex concentrate (PCC), factor VIIa, tranexamic acid and desmopressin. The above-mentioned drugs were stored in a special “coagulation box” in the hospital pharmacy, and this box could be immediately brought to the SR or operating room (OR) upon request. Despite the use of clotting factors, transfusions using red blood cells (RBC) and fresh frozen plasma (FFP) were performed at an RBC-to-FFP ratio of 2:1 to 1:1.ResultsOver a 12-month investigation period, 123 severe multiple trauma patients needing intensive care therapy were admitted to our trauma center (mean age 48 years, mean ISS (injury severity score) 30). Fourteen (11%) patients died; 25 (mean age 51.5 years, mean ISS 53) of the 123 patients were treated using the “coagulation box,” and 17 patients required massive transfusions. Patients treated with the “coagulation box” required an average dose of 16.3 RBC and 12.9 FFP, whereas 17 of the 25 patients required an average dose of 3.6 platelet packs. According to the algorithm, 25 patients received fibrinogen (average dose of 8.25 g), 24 (96%) received PCC (3000 IU.), 14 (56%) received desmopressin (36.6 µg), 13 (52%) received tranexamic acid (2.88 g), and 11 (44%) received factor VIIa (3.7 mg). The clotting parameters markedly improved between SR admission and ICU admission. Of the 25 patients, 16 (64%) survived. The revised injury severity classification (RISC) predicted a survival rate of 41%, which corresponds to a standardized mortality ratio (SMR) of 0.62, which implies a higher survival rate than predicted.ConclusionsAn Hb-driven algorithm, in combination with the “coagulation box” and the early use of clotting factors, could be a simple and effective tool for improving coagulopathy in multiple trauma patients.

show abstract

Section: Methodssupporting

confidence: 59%

Section: Discussionmentioning

confidence: 60%

See 1 more Smart Citation

The “Coagulation Box” and a New Hemoglobin-Driven Algorithm for Bleeding Control in Patients With Severe Multiple Traumas

et al. 2013

View full text Add to dashboard Cite

show abstract

“…There is also evidence suggesting that the Hb level on admission is a surrogate for estimated blood loss and provides the basis for a successful calculation of requirements for the replacement of clotting products [ 27 – 29 ]. The international normalised ratio (INR) is discussed as another parameter for an assessment of trauma-induced dilutional coagulopathy and has been established as a POC test for patients on anticoagulant therapy.…”

Section: Focused Diagnostic Laboratory and Imaging Proceduresmentioning

confidence: 99%

Terrorist incidents: strategic treatment objectives, tactical diagnostic procedures and the estimated need of blood and clotting products

Franke

Bieler

Friemert³

et al. 2020

Eur J Trauma Emerg Surg

View full text Add to dashboard Cite

Background Terrorism-related incidents that are associated with mass casualties (mass-casualty terrorist incidents) are a medical and organisational challenge for every hospital because of the special injury patterns involved, the time of the incident, the development of the situation, the initial lack of information, the number of injured, and the number of uninjured survivors who self-refer to a hospital. Methods The Terror and Disaster Surgical Care (TDSC®)-Course was developed in order to address mass-casualty terrorist incidents and to provide surgeons with the specialist medical and surgical knowledge and skills required for these special situations. The focus of the TDSC® course is on how to provide surgical care and how to deploy scarce resources in a particular tactical situation in such a way that the number of survivors is maximised. Results The effective management of such a tactical situation must be based on priorities and first and foremost requires the standardised sorting and categorisation of the injured at the hospital. The aim of triage, or the sorting of the injured, is to immediately identify patients with life-threatening injuries in environments with strained resources. The medical management of mass-casualty terrorist incidents requires tactical abbreviated surgical care (TASC) teams that have the skills needed to perform a primary survey and to provide care for casualties who need immediate surgery (triage category 1-T1). Initial fluid therapy should be restrictive (permissive hypotension) unless contraindicated. Clotting products are replaced in a standardised manner on the basis of patient requirements, which are calculated using rapidly available surrogates (blood gas analysis). Blood products can be administered or kept available depending on risks and triage categories. The highest priority should be given to the identification and management of haemodynamically unstable patients who require immediate surgery for injuries associated with bleeding into body cavities (T1 + +). Conclusion The recommendations and approaches described here should be considered as proposals for hospitals to develop standards or modify well-established standards that enable them to prepare themselves successfully for situations (e.g. masscasualty terrorist or shooter incidents) in which their resources are temporarily overwhelmed.

show abstract

Basisalgorithmus für „Point-of-Care“ basierte Hämotherapie

et al. 2013

View full text Add to dashboard Cite

During perioperative treatment of coagulopathic patients the so-called Point-of-Care (POC) analyses enable more rapidly available and more comprehensive hemostatic analyses compared to routinely performed conventional coagulation testing, such as activated partial thromboplastin time (aPTT), international normalized ratio (INR), fibrinogen concentration and platelet count. In this review article a hemotherapy algorithm is presented which is based on viscoelastic and aggregometric POC measurements. The algorithm was designed double sided and consists of a general and a special part. The general part contains boxes and fields for sociodemographic data and gives general recommendations for coagulation management and therapy specifications for particular patient collectives and presents proposals for emergency reversal of anticoagulation therapy. The special part refers to basic physiological conditions for hemostasis and asks for measurement results of clot initiation, clot firmness, clot stability and platelet function analyses. Reference values were defined for each parameter and therapeutic options are presented. In cases of persistent coagulopathy despite algorithm-conform therapy, the algorithm could be run through once again. Finally, the algorithm presents therapeutic options for an ultima ratio therapy approach.

show abstract

Gerinnungsmanagement beim kreislaufinstabilen Polytraumapatienten

Abstract: The Hb-driven algorithm, in combination with the coagulation box and the early use of clotting factors, may be a simple and effective tool for improving coagulopathy in multiple trauma patients.

Cited by 9 publications

References 20 publications

The “Coagulation Box” and a New Hemoglobin-Driven Algorithm for Bleeding Control in Patients With Severe Multiple Traumas

The “Coagulation Box” and a New Hemoglobin-Driven Algorithm for Bleeding Control in Patients With Severe Multiple Traumas

Terrorist incidents: strategic treatment objectives, tactical diagnostic procedures and the estimated need of blood and clotting products

Basisalgorithmus für „Point-of-Care“ basierte Hämotherapie

Contact Info

Product

Resources

About