Less Impairment of Hemostasis and Reduced Blood Loss in Pigs After Resuscitation from Hemorrhagic Shock Using the Small-Volume Concept with Hypertonic Saline/Hydroxyethyl Starch as Compared to Administration of 4% Gelatin or 6% Hydroxyethyl Starch Solution

Haas, Thorsten; Fries, Dietmar; Holz, Carmen; Innerhofer, Petra; Streif, Werner; Klingler, Antón; Hanke, Alexander; Velik‐Salchner, Corinna

doi:10.1213/ane.0b013e318165df18

Cited by 44 publications

(31 citation statements)

References 21 publications

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“…[30][31][32] Starches have also been shown to affect measurement of plasma fibrinogen concentration with the Clauss method. 33 Therefore, the use of HES 130/0.4 in our population may have contributed to the lower MCF cut-off value.…”

Section: Discussionmentioning

confidence: 99%

Plasma fibrinogen concentration is correlated with postoperative blood loss in children undergoing cardiac surgery

Faraoni

Willems

Savan

et al. 2014

European Journal of Anaesthesiology

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Post-CPB plasma fibrinogen concentration significantly influences blood loss in children undergoing cardiac surgery. A fibrinogen concentration of at least 1.5 g l or a MCF of at least 3 mm should accurately predict excessive blood loss in cardiac surgery children. Further prospective trials are needed to assess the effect of fibrinogen supplementation on postoperative blood loss in this population.

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Section: Discussionmentioning

confidence: 99%

Plasma fibrinogen concentration is correlated with postoperative blood loss in children undergoing cardiac surgery

Faraoni

Willems

Savan

et al. 2014

European Journal of Anaesthesiology

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“…Some in vitro and in vivo studies have reported an anticoagulant effect or impaired platelet function after the use of hyperosmolar solutions, whereas new animal studies found less impairment of the plasmatic coagulation system compared with HES and gelatin 24 .…”

Section: Dilutional Coagulopathymentioning

confidence: 99%

Emerging treatment strategies for trauma-induced coagulopathy (Br J Surg 2012; 99(Suppl 1): 40–50)

Johansson

2011

British Journal of Surgery

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Background: Trauma-induced coagulopathy has a multifactorial aetiology. Coagulopathy is related to blood loss including consumption of clotting factors and platelets and haemodilution. Additionally hyperfibrinolysis, hypothermia, acidosis and metabolic changes affect the coagulation system.Methods: This is a review of pathophysiology and new treatment strategies for trauma-induced coagulopathy.Results: Paradigms are actively changing and there is still a shortage of data. The aim of any haemostatic therapy is to control bleeding and minimize blood loss and transfusion requirements. Transfusion of allogeneic blood products as well as trauma-induced coagulopathy cause increased morbidity and mortality. Current opinion is based on present studies and results from small case series, combined with findings from experimental studies in animals, in vitro studies and expert opinions, as opposed to large, randomized, placebo-controlled studies. A summary of new and emerging strategies, including medical infusion and blood products, to beneficially manipulate the coagulation system in the critically injured patient is suggested. Conclusion:Future treatment of trauma-induced coagulopathy may be based on systemic antifibrinolytics, local haemostatics and individualized point-of-care-guided rational use of coagulation factor concentrates such as fibrinogen, prothrombin complex concentrate, recombinant factor VIIa and factor XIII. The authors speculate that timely and rational use of coagulation factor concentrates will be more efficacious and safer than ratio-driven use of transfusion packages of allogeneic blood products.

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“…Dies wird in den aktuellen BÄKEmpfehlungen expli zit betont [13]. Der Einfluss von 4 ml/kg KG hypertoner/hyperonkotischer HAES Lösung auf die Gerinnselbildung war in einer thrombelastometrischen Studie mit Schweinen deutlich geringer als der von 6% HAES 130/0,4 oder 4%iger Gelatine lösung [31]. Um ein ausreichendes Sau erstoffangebot im Gewebe zu erreichen, sind die Zielwerte der Volumensubstitu tion ein mittlerer arterieller Druck ("me an arterial pressure", MAP) von ≥65 mm Hg bzw.…”

Section: Permissive Hypotensionunclassified

Coagulation management in the treatment of multiple trauma

2009

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In recent years a new understanding of trauma-associated hemorrhaging and trauma-induced coagulopathy has been achieved. This coagulopathy is multifactorial with the predominant mechanisms being tissue trauma, shock and hypoperfusion which can lead to hyperfibrinolysis by activation of the endothelium. Routinely tested coagulation parameters, such as prothrombin time and partial thromboplastin time, are frequently employed for decision making but remain problematic as they do not give any information on clot stability, lysis or platelet function. Thrombelastometry seems to be a useful alternative. A pro-active anticipatory approach is required for a successful outcome to be achieved as rescue correction is more difficult than prevention. While the pathophysiological conception of causal relationship of the mentioned therapeutic options is conclusive, an evidence-based validation by randomized controlled studies is mostly lacking. The emergency and anesthesiological concept of damage control resuscitation consists of limiting volume therapy with crystalloids and colloids to reach a mean arterial pressure > or =65 mmHg (higher for head injuries), active (re-)warming management, the prevention of a pH< or =7.2 and a base excess (BE) < or =-6 mmol/l. The early and sufficient application of hemostatic drugs is essential. Because erythrocytes play a substantial role in the coagulation process, hemoglobin (Hb) values of around 6. 2 mmol/l (10 g/dl) and/or a hematocrit of 30% should be strived for when massive non-arrested hemorrhaging occurs. After severe multiple trauma a fibrinogen deficit develops and must be adequately compensated. If coagulation therapy is carried out using fresh frozen plasma sufficient quantities (20-30 ml/kgBW) must be administered to correspondingly raise the coagulation factors. Prothrombin complex concentrates can be helpful to optimize thrombin generation during severe hemorrhaging. Because hyperfibrinolysis occurs more often than previously assumed during severe trauma, an anti-fibrinolytic therapy should be used especially for patients with an instable circulation. The platelet count should not go below 100,000/microl when hemorrhaging occurs after multiple trauma. For thrombocytopathic patients with diffuse bleeding desmopressin (DDAVP) is a therapeutic option and the "off label" use of recombinant activated factor VIIa (rFVIIa) remains an option for individual situations with stringent indications and when the above named measures to optimize the coagulation situation have been taken.

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Less Impairment of Hemostasis and Reduced Blood Loss in Pigs After Resuscitation from Hemorrhagic Shock Using the Small-Volume Concept with Hypertonic Saline/Hydroxyethyl Starch as Compared to Administration of 4% Gelatin or 6% Hydroxyethyl Starch Solution

Abstract: Resuscitation from hemorrhagic shock with HS-HES 200/0.62 results in less impairment of clot formation when compared with compensation of blood loss by administering 6% HES 130/0.4 or 4% gelatin.

Cited by 44 publications

References 21 publications

Plasma fibrinogen concentration is correlated with postoperative blood loss in children undergoing cardiac surgery

Plasma fibrinogen concentration is correlated with postoperative blood loss in children undergoing cardiac surgery

Emerging treatment strategies for trauma-induced coagulopathy (Br J Surg 2012; 99(Suppl 1): 40–50)

Coagulation management in the treatment of multiple trauma

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