Abstract
IntroductionThe optimal transfusion protocol remains unknown in the trauma setting. This retrospective cohort study aimed to determine if goal-directed transfusion protocol based on standard thrombelastography (TEG) is feasible and beneficial in patients with abdominal trauma.MethodsSixty adult patients with abdominal trauma who received 2 or more units of red blood cell transfusion within 24 hours of admission were studied. Patients managed with goal-directed transfusion protocol via TEG (goal-directed group) were compared to patients admitted before utilization of the protocol (control group).ResultsThere were 29 patients in the goal-directed group and 31 in the control group. Baseline parameters were similar except for higher admission systolic blood pressure in the goal-directed group than the control group (121.8 ± 23.1 mmHg vs 102.7 ± 26.5 mmHg, p < 0.01). At 24 h, patients in the goal-directed group had shorter aPTT compared to patients in the control group (39.2 ± 16.3 s vs 58.6 ± 36.6 s, p = 0.044). Administration of total blood products at 24 h appeared to be fewer in the goal-directed group than the control group (10.2 [7.0-43.1]U vs 14.8 [8.3-37.6]U, p = 0.28), but this was not statistically significant. Subgroup analysis including patients with ISS ≥16 showed that patients in the goal-directed group had significantly fewer consumption of total blood products than patients in the control group (7[6.1, 47.0]U vs 37.6[14.5, 89.9]U, p = 0.015). No differences were found in mortality at 28d, length of stay in intensive care unit and hospital between the two groups.ConclusionsGoal-directed transfusion protocol via standard TEG was achievable in patients with abdominal trauma. The novel protocol, compared to conventional transfusion management, has the potential to decrease blood product utilization and prevent exacerbation of coagulation function.
Highlights
The optimal transfusion protocol remains unknown in the trauma setting
Patient characteristics A total of 150 patients with abdominal trauma were admitted between November 2008 and October 2012, of whom 98 met the inclusion criteria
No significant differences were found in mortality at 28d, length of stay in ICU and hospital between the two groups. This cohort study showed that goal-directed transfusion protocol via TEG was applicable in patients with abdominal trauma, and was associated with a trend towards fewer blood product utilization and better coagulation profile at 24 h compared to conventional transfusion management
Summary
The optimal transfusion protocol remains unknown in the trauma setting. This retrospective cohort study aimed to determine if goal-directed transfusion protocol based on standard thrombelastography (TEG) is feasible and beneficial in patients with abdominal trauma. The optimal transfusion protocol for trauma patients remains unknown. In lack of guidance by rapid and comprehensive tools monitoring coagulation status, current transfusion protocols are unable to utilize blood products according to individual demands. As a consequence, these protocols are likely to lead to inappropriate and excessive administration of blood products, which is associated with increased burden of blood product supply and risk of transfusion-related morbidity
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