Abstract
Major hemorrhage is often associated with trauma-induced coagulopathy. Targeted blood product replacement could achieve faster hemostasis and reduce mortality. This study aimed to investigate whether thromboelastography (TEG®) goal-directed transfusion improved blood utilization, reduced mortality, and was cost effective. Data were prospectively collected in a U.K. level 1 trauma center, in patients with major hemorrhage one year pre- and post-implementation of TEG® 6s Hemostasis Analyzers. Mortality, units of blood products transfused, and costs were compared between groups. Patient demographics in pre-TEG (n = 126) and post-TEG (n = 175) groups were similar. Mortality was significantly lower in the post-TEG group at 24 h (13% vs. 5%; p = 0.006) and at 30 days (25% vs. 11%; p = 0.002), with no difference in the number or ratio of blood products transfused. Cost of blood products transfused was comparable, with the exception of platelets (average £38 higher post-TEG). Blood product wastage was significantly lower in the post-TEG group (1.8 ± 2.1 vs. 1.1 ± 2.0; p = 0.002). No statistically significant difference in cost was observed between the two groups (£753 ± 651 pre-TEG; £830 ± 847 post-TEG; p = 0.41). These results demonstrate TEG 6s-driven resuscitation algorithms are associated with reduced mortality, reduced blood product wastage, and are cost neutral compared to standard coagulation tests.
Highlights
Thirty percent of patients with major hemorrhage in trauma develop associated trauma-induced coagulopathy (TIC) [1,2,3]
A trauma patient presenting with major hemorrhage will activate the massive transfusion protocol (MTP) and is categorized as a code red patient
This study demonstrates that the use of TEG 6s in a trauma setting improves patient outcomes and is cost neutral compared with standard coagulation tests
Summary
Thirty percent of patients with major hemorrhage in trauma develop associated trauma-induced coagulopathy (TIC) [1,2,3]. The wars in Iraq and Afghanistan focused attention on trauma resuscitation and the use of blood and blood products in a 1:1:1 ratio. Optimal Platelet and Plasma Ratios (PROPPR) and Prospective, Observational, Multicenter, Major Trauma. A trauma patient presenting with major hemorrhage will activate the massive transfusion protocol (MTP) and is categorized as a code red patient. This results in them receiving multiple blood products such as packed red blood cells (RBCs), platelets, and fresh frozen plasma (FFP) [6,7,8]. Further blood product requirement is often directed by routine coagulation testing, Diagnostics 2020, 10, 486; doi:10.3390/diagnostics10070486 www.mdpi.com/journal/diagnostics
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