Mortality from trauma haemorrhage and opportunities for improvement in transfusion practice

Stanworth, Simon; Davenport, Ross; Curry, Nicola; Seeney, Frances; Eaglestone, Simon; Edwards, Antoinette; Martin, Kate; Allard, Shubha; Woodford, Maralyn; Lecky, Fiona; Brohi, Karim

doi:10.1002/bjs.10052

Cited by 105 publications

(89 citation statements)

References 24 publications

(20 reference statements)

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“…These findings are supported by a recently published study from the UK investigating transfusion practices in traumatic haemorrhage -the median time to delivery of cryoprecipitate as part of a MHP was more than 2 hours and almost 50% of patients did not receive cryoprecipitate as part of their initial resuscitation (54). This is concerning, considering that the median time to death from haemorrhage is reported to be approximately 2.6 hours (48) (54).…”

Section: Fibrinogen Replacement As Part Of a Mhpsupporting

confidence: 55%

“…The impressive delivery of blood component therapy as described in the PROPPR trial may be difficult to translate into routine clinical practise (53). A recent study from Stanworth et al reports widespread variations in patterns of blood product delivery across a number of trauma centres, with few patients receiving an 'optimal' product ratio (54).…”

Section: Major Haemorrhage Protocols (Mhp)mentioning

confidence: 99%

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Fibrinogen in traumatic haemorrhage: A narrative review

Winearls

Campbell

Hurn

et al. 2017

Injury

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Abstract:Haemorrhage in the setting of severe trauma is associated with significant morbidity and mortality. There is increasing awareness of the important role fibrinogen plays in traumatic haemorrhage. Fibrinogen levels fall precipitously in severe trauma and the resultant hypofibrinogenaemia is associated with poor outcomes. Hence, it has been postulated that early fibrinogen replacement in severe traumatic haemorrhage may improve outcomes, although, to date there is a paucity of high quality evidence to support this hypothesis. In addition there is controversy regarding the optimal method for fibrinogen supplementation. We review the current evidence regarding the role of fibrinogen in trauma, the rationale behind fibrinogen supplementation and discuss current research.

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Section: Fibrinogen Replacement As Part Of a Mhpsupporting

confidence: 55%

Section: Major Haemorrhage Protocols (Mhp)mentioning

confidence: 99%

Fibrinogen in traumatic haemorrhage: A narrative review

Winearls

Campbell

Hurn

et al. 2017

Injury

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“…A number of studies have reported that the fixed-ratio MHP is ineffective in maintaining adequate fibrinogen levels [24, 37]. Additionally there can be significant time delays to Cryo transfusion and a large proportion of patients do not receive Cryo as part of a fixed-ratio MHP [38, 39]. The CRYOSTAT trial has shown that it is feasible to utilise Cryo empirically as part of a fixed-ratio MHP; however, the median time to transfusion was still 60 min [28].…”

Section: Discussionmentioning

confidence: 99%

Fibrinogen Early In Severe Trauma studY (FEISTY): study protocol for a randomised controlled trial

Winearls

Wullschleger

Wake

et al. 2017

Trials

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BackgroundHaemorrhage is a leading cause of death in severe trauma. Fibrinogen plays a critical role in maintaining haemostasis in traumatic haemorrhage. Early fibrinogen replacement is recommended by several international trauma guidelines using either fibrinogen concentrate (FC) or cryoprecipitate (Cryo). There is limited evidence to support one product over the other with widespread geographic and institutional variation in practice. This pilot trial is the first randomised controlled trial comparing FC to Cryo in traumatic haemorrhage.Methods/designThe Fibrinogen Early In Severe Trauma studY (FEISTY) is an exploratory, multicentre, randomised controlled trial comparing FC to Cryo for fibrinogen supplementation in traumatic haemorrhage. This trial will utilise thromboelastometry (ROTEM®) to guide and dose fibrinogen supplementation. The trial will recruit 100 trauma patients at four major trauma centres in Australia. Adult trauma patients with evidence of haemorrhage will be enrolled on arrival in the trauma unit and randomised to receiving fibrinogen supplementation with either FC or Cryo. The primary outcome is the differential time to fibrinogen supplementation. There are a number of predetermined secondary outcomes including: effects of the intervention on plasma fibrinogen levels, feasibility assessments and clinical outcomes including transfusion requirements and mortality.DiscussionThe optimal method for replacing fibrinogen in traumatic haemorrhage is fiercely debated. In this trial the feasibility and efficacy of fibrinogen supplementation using FC will be compared to Cryo. The results of this pilot study will facilitate the design of a larger trial with sufficient power to address patient-centred outcomes.Trial registrationClinicalTrials.gov, ID: NCT02745041. Registered 4 May 2016.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-017-1980-x) contains supplementary material, which is available to authorized users.

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“…In the UK, a national study prospectively evaluated transfusion practice in trauma hemorrhage, including fibrinogen supplementation at 22 trauma centers (major trauma centers and trauma units) between 2009 and 2011. 32 The median time to cryoprecipitate transfusion was 156 minutes at a major trauma center (184 minutes in a trauma unit), by which time 50% of patients had died. Although the reasons for delays in cryoprecipitate transfusion were not collected as part of this study, this is an important area where further work is needed to better understand the barriers to timely transfusion support.…”

Section: Acquired Hypofibrinogenemiamentioning

confidence: 99%

“…45 Despite this, specific fibrinogen replacement appears late in current major hemorrhage transfusion therapy as seen in observational and prospective studies, eg, PROPPR and PROMMT studies. 32,46,47 A potential reason for the late administration of cryoprecipitate is the time taken for preparation and thawing (in some centers there is additional time required for pooling of the individual cryoprecipitate units).…”

Section: Traumamentioning

confidence: 99%