Targeted resuscitation improves coagulation and outcome

Doran, Catherine; Woolley, Tom; Carter, Alun; Male, Keith B.; Midwinter, Mark J.; Mahoney, Peter F.; Watts, Sarah; Kirkman, Emrys

doi:10.1097/ta.0b013e318248347b

Cited by 48 publications

(39 citation statements)

References 30 publications

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“…Improvements in survival rates have been associated with these 'damage control' or 'haemostatic' resuscitation regimens that have been retrospectively attributed to improvements in haemostatic function (51,52,82). However a recent study by Kahn and colleagues suggests this is not the case, with ongoing deterioration of coagulation function evident in the face of haemostatic resuscitation (80).…”

Section: Background Of Acute Traumatic Coagulopathymentioning

confidence: 80%

“…Resuscitation practices in trauma have shifted away from crystalloid based regimens towards the use of whole blood, or red cell concentrates in combination with plasma, fibrinogen, cryoprecipitate and platelets (51,52,80,81). Improvements in survival rates have been associated with these 'damage control' or 'haemostatic' resuscitation regimens that have been retrospectively attributed to improvements in haemostatic function (51,52,82).…”

Section: Background Of Acute Traumatic Coagulopathymentioning

confidence: 99%

“…porcine models with varying effects on coagulation function observed (29, 40,51,65,67,177,[200][201][202][203]. All rodent models demonstrated a minimum 20% prolongation in PT, aPTT or PT ratio (PTr) (29, 40, 65) which was attenuated by monoclonal antibodies to aPC in one study (40).…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Haemostatic resuscitation using combinations of red blood cells, plasma, platelets, cryoprecipitate and fibrinogen remains the core therapeutic approach to severe trauma (51,52), and has been combined with adjuncts such as prothrombin complex, recombinant activated factor VII and tranexamic acid (TXA) to further improve haemorrhage control (53).This may improve short term mortality rates (52); however the effect on the subsequent pro-coagulant state still needs to be quantified. TXA has also been shown to impede neutrophil adhesion pathways via the inhibition of plasmin (54,55).…”

Section: Intrinsic Pathway Extrinsic Pathwaymentioning

confidence: 99%

“…This results in an increased risk of post injury multi-organ failure, sepsis and thromboembolic complications in the long term (98). The current core therapeutic approach to patients with traumatic injury is the use of hemostatic resuscitation to restore circulatory homeostasis and control hemorrhage (51,81). Whilst this improves mortality rates it may influence the development of a subsequent pro-coagulant state (121).…”

Section: Introductionmentioning

confidence: 99%

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Validation of acute traumatic coagulopathy in an ovine model of trauma and haemorrhage

Zyl¹

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This thesis describes an ovine model of complex trauma and haemorrhage that demonstrates coagulation changes using both traditional plasma based assays and point of care viscoelastic assays that are consistent with current definitions of ATC. The degree of coagulopathy was correlated with the degree of shock as quantified by arterial lactate.Coagulopathy was also associated with activation of the protein C pathway and shedding of the endothelial glycocalyx. Fibrinolysis did not make a significant contribution to the coagulopathy observed and there was no evidence of altered platelet function in this model.ii

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Section: Background Of Acute Traumatic Coagulopathymentioning

confidence: 80%

Section: Background Of Acute Traumatic Coagulopathymentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Intrinsic Pathway Extrinsic Pathwaymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Validation of acute traumatic coagulopathy in an ovine model of trauma and haemorrhage

Zyl¹

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Temporary abdominal closure and delayed biliary reconstruction due to massive bleeding in patients undergoing liver transplantation: an old trick in a new indication

Komorowski

Millan

et al. 2016

J Hepato Biliary Pancreat

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BackgroundMassive bleeding during liver transplantation (LT) is difficult to manage surgical event. Perihepatic packing (PP) and temporary abdominal closure (TAC) with delayed biliary reconstruction (DBR) can be applied in these circumstances.MethodA prospective database of LT in a major transplant center was analyzed to identify patients with massive uncontrollable bleeding during LT that was resolved by PP, TAC, and DBR.ResultsFrom 2009 to 2013, 20 (3.6%) of 547 patients who underwent LT underwent DBR. Mean intraoperative blood loss was 20,500 ml at the first operation. The DBR was performed with a mean of 55.2 h (16–110) after LT. Biliary reconstruction included duct‐to‐duct (n = 9) and hepatico‐jejunostomy (n = 11). Complications occurred in eight patients and included portal vein thrombosis, cholangitis, severe bacteremia, pneumonia. There was one in‐hospital death. In the follow‐up of 18 to 33 months we have seen one patient died 9 months after transplantation. The remaining 18 patients are alive and well.ConclusionsIn case of massive uncontrollable bleeding and bowel edema during LT, the combined procedures of PP, TAC, and DBR offer an alternatively surgical option to solve the tough situation.

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Animal Models of Coagulopathy

Lammers

Martin

2020

Trauma Induced Coagulopathy

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Targeted resuscitation improves coagulation and outcome

Cited by 48 publications

References 30 publications

Validation of acute traumatic coagulopathy in an ovine model of trauma and haemorrhage

Validation of acute traumatic coagulopathy in an ovine model of trauma and haemorrhage

Temporary abdominal closure and delayed biliary reconstruction due to massive bleeding in patients undergoing liver transplantation: an old trick in a new indication

Animal Models of Coagulopathy

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