EARLY COAGULOPATHY AND MASSIVE TRANSFUSION (MT) IN CIVILIAN TRAUMA AND COMBAT CASUALTIES

Abstract

Objective: Current ATLS standard of normotensive resuscitation results in disproportionate crystalloid to packed red blood cell (PRBC) administration. Recent studies advocate earlier fresh frozen plasma (FFP) based on the premise that patients are coagulopathic prior to MT. The purpose of the study was to compare civilian and military trauma patients who required MT (>10 U PRBC). Methods: Research databases from a regional Level I US Trauma center and a Combat Support Hospital were reviewed. Patient demographic and resuscitative variables were compared. Data are expressed as mean ± SD, * P < 0.05. Results: The combat cohort was younger, but both cohorts had high injury severity score (ISS) and similar survival. Admission hemoglobin concentration ([Hb]), temperature (T), base deficit (BD), and International Normalized Ratio (INR) were similar. Admission INR indicated moderate to severe coagulopathy. Civilian patients received care consistent with ATLS guidelines, receiving isotonic crystalloid to PRBC in a 3:1 ratio and FFP administration delayed until after 6 units PRBC. Combat casualties received colloid in the field followed by isotonic crystalloid to PRBC in a 2:1 ratio and similar FFP transfusion. Following resuscitation, INR remained elevated in both cohorts. Conclusion: Consistent with recent literature, combat and civilian trauma patients were coagulopathic prior to MT. Moreover, current military and civilian MT practice does not correct this coagulopathy. Based on this study, the civilian population appears to be an appropriate model for the evaluation of more aggressive haemostatic shock resuscitation.Table