Massive transfusion policies at trauma centers participating in the American College of Surgeons Trauma Quality Improvement Program

Camazine, Maraya; Hemmila, Mark R.; Leonard, Julie C.; Jacobs, Rachel A.; Horst, Jennifer; Kozar, Rosemary A.; Bochicchio, Grant V.; Nathens, Avery B.; Cryer, Henry; Spinella, Philip C.

doi:10.1097/ta.0000000000000641

Cited by 106 publications

(82 citation statements)

References 23 publications

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“…These outcomes have prompted several organizations to recommend the clinical use of viscoelastic hemostatic testing devices, such as TEG, in various clinical areas. [4][5][6][7] The disadvantages of viscoelastic hemostatic assays have historically included a relatively high coefficient of variation, poorly standardized methodologies, and limitations on the specimen stability of native whole blood samples. [8][9][10] In the pediatric setting, an advantage of the TEG is the relatively small sample volume needed, but a disadvantage is the difference in reference ranges between infants, especially newborns, and adults.…”

mentioning

confidence: 99%

New-Generation Thromboelastography: Comprehensive Evaluation of Citrated and Heparinized Blood Sample Storage Effect on Clot-Forming Variables

Dias¹,

Haney²,

Mathew³

et al. 2017

Archives of Pathology &Amp; Laboratory Medicine

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Context.-Thromboelastography (TEG) is a whole blood, real-time analyzer measuring the viscoelastic properties of the hemostasis process and allowing for individualized goal-directed therapy. However, routine use of TEG requires validation of sample storage effect on clot parameters.Objectives.-To establish the minimum time required for equilibration time and the maximum time for sample storage for all commercially available TEG tests for the new-generation TEG 6s and to determine how those times compare with the older generation TEG 5000.Design.-Citrated and heparinized whole blood samples obtained from 20 healthy donors were analyzed for clot parameters at multiple time points for both the TEG 6s and the TEG 5000. Samples were activated with the citrated multichannel cartridge or the platelet-mapping cartridge in the TEG 6s or with recalcified kaolin in the TEG 5000.Results.-All blood samples yielded TEG parameter results within reference ranges and had a tendency toward hypercoagulable profiles with increased storage time. Sample storage resulted in increased platelet inhibition with significant differences at 4 hours in the plateletmapping cartridge (arachidonic acid percentage of inhibition, P ¼ .002; adenosine diphosphate percentage of inhibition, P ¼ .02).Conclusions.-For nonemergent cases or in a central laboratory setting, all tests provided reliable results for up to 4 hours in the citrated multichannel cartridge and for 3 hours for platelet function information in the plateletmapping cartridge. In emergent/urgent situations in which the sample needs to be run immediately, RapidTEG and functional fibrinogen tests may be preferred.

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mentioning

confidence: 99%

New-Generation Thromboelastography: Comprehensive Evaluation of Citrated and Heparinized Blood Sample Storage Effect on Clot-Forming Variables

Dias¹,

Haney²,

Mathew³

et al. 2017

Archives of Pathology &Amp; Laboratory Medicine

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“…Viscoelastic assays deliver partial results within 10–15 minutes of test initiation, allowing attractively rapid post-admission coagulopathy evaluation at the minority of level 1 trauma centers where these assays are available [57, 58]. However, startup costs, assay system interchangeability and reliability issues, and particularly the absence of a consensus outcome-linked viscoelastic ATC definition pose barriers to the application of viscoelastic assays in clinical care and research outside high-volume, high-resource trauma centers [20, 57, 59, 60].…”

Section: Discussionmentioning

confidence: 99%

Development and validation of a prehospital prediction model for acute traumatic coagulopathy

et al. 2016

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BackgroundAcute traumatic coagulopathy (ATC) is a syndrome of early, endogenous clotting dysfunction that afflicts up to 30% of severely injured patients, signaling an increased likelihood of all-cause and hemorrhage-associated mortality. To aid identification of patients within the likely therapeutic window for ATC and facilitate study of its mechanisms and targeted treatment, we developed and validated a prehospital ATC prediction model.MethodsConstruction of a parsimonious multivariable logistic regression model predicting ATC — defined as an admission international normalized ratio >1.5 — employed data from 1963 severely injured patients admitted to an Oregon trauma system hospital between 2008 and 2012 who received prehospital care but did not have isolated head injury. The prediction model was validated using data from 285 severely injured patients admitted to a level 1 trauma center in Seattle, WA, USA between 2009 and 2013.ResultsThe final Prediction of Acute Coagulopathy of Trauma (PACT) score incorporated age, injury mechanism, prehospital shock index and Glasgow Coma Score values, and prehospital cardiopulmonary resuscitation and endotracheal intubation. In the validation cohort, the PACT score demonstrated better discrimination (area under the receiver operating characteristic curve 0.80 vs. 0.70, p = 0.032) and likely improved calibration compared to a previously published prehospital ATC prediction score. Designating PACT scores ≥196 as positive resulted in sensitivity and specificity for ATC of 73% and 74%, respectively.ConclusionsOur prediction model uses routinely available and objective prehospital data to identify patients at increased risk of ATC. The PACT score could facilitate subject selection for studies of targeted treatment of ATC.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-016-1541-9) contains supplementary material, which is available to authorized users.

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“…Participants also noted the marked variability between laboratories and assay systems (6–8). Finally, unless these tests’ availability improves — just 23% of level I and 10% of level II trauma centers in the United States presently use them (9) — a definition based solely on viscoelastic assays would preclude diagnosis of most patients with ATC.…”

Section: The Authors Respondmentioning

confidence: 99%

The authors reply

Peltan

Watkins

2016

Critical Care Medicine

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Massive transfusion policies at trauma centers participating in the American College of Surgeons Trauma Quality Improvement Program

Cited by 106 publications

References 23 publications

New-Generation Thromboelastography: Comprehensive Evaluation of Citrated and Heparinized Blood Sample Storage Effect on Clot-Forming Variables

New-Generation Thromboelastography: Comprehensive Evaluation of Citrated and Heparinized Blood Sample Storage Effect on Clot-Forming Variables

Development and validation of a prehospital prediction model for acute traumatic coagulopathy

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