Abstract
BackgroundTrauma-induced coagulopathy (TIC) is a life-threatening condition associated with high morbidity and mortality. TIC can present with different coagulation defects. In this study, the aim was to determine the effect of shock duration on TIC characteristics. We hypothesized that longer duration of shock leads to a more hypocoagulable rotational thromboelastometry (ROTEM) profile compared to a shorter duration of shock.MethodsMale B57BL/6J(c) mice (n = 5–10 per group) were sedated and mechanically ventilated. Trauma was induced by bilateral lower limb fractures and crush injuries to the liver and small intestine. Shock was induced by blood withdrawals until a mean arterial pressure of 25–30 mmHg was achieved. Groups reflected trauma and shock for 30 min (TS30) and trauma and shock for 90 min (TS90). Control groups included ventilation only (V90) and trauma only (T90).ResultsMice in the TS90 group had significantly increased base deficit compared to the V90 group. Mortality was 10% in the TS30 group and 30% in the TS90 group. ROTEM profile was more hypocoagulable, as shown by significantly lower maximum clot firmness (MCF) in the TS30 group (43.5 [37.5–46.8] mm) compared to the TS90 group (52.0 [47.0–53.0] mm, p = 0.04). ROTEM clotting time and parameters of clot build-up did not significantly differ between groups.ConclusionsTIC characteristics change with shock duration. Contrary to the hypothesis, a shorter duration of shock was associated with decreased maximum clotting amplitudes compared to a longer duration of shock. The effect of shock duration on TIC should be further assessed in trauma patients.
Highlights
Trauma-induced coagulopathy (TIC) is a life-threatening condition associated with high morbidity and mortality
Haemorrhaging trauma patients frequently present with trauma-induced coagulopathy (TIC), which is associated with increased transfusion requirements and mortality [2, 3]
Shock and mortality The amount of blood withdrawn to reach the predefined mean arterial pressure (MAP) target was similar between groups: 330 μl (± 40 μl) in trauma and shock for 30 min (TS30) group and: 350 μl (± 60 μl) in the trauma and shock for 90 min (TS90) group
Summary
Trauma-induced coagulopathy (TIC) is a life-threatening condition associated with high morbidity and mortality. The aim was to determine the effect of shock duration on TIC characteristics. Haemorrhaging trauma patients frequently present with trauma-induced coagulopathy (TIC), which is associated with increased transfusion requirements and mortality [2, 3]. Sloos et al Intensive Care Medicine Experimental (2022) 10:1 coagulation factor depletion, dysfunctional platelets and hyperfibrinolysis [5,6,7]. These components lead to an unstable clot formation and reduced clot strength, resulting in a disability to control the ongoing haemorrhage [8]. We hypothesised that longer duration of shock, is associated with a more hypocoagulable profile compared to short duration of shock
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