Exsanguination protocol improves survival after major hepatic trauma

Area of Science:

• Trauma Surgery
• Hepatobiliary Surgery
• Resuscitation Medicine

Background:

• Hepatic injury is a major cause of death from exsanguination after major trauma.
• Trauma Exsanguination Protocols (TEP) have shown promise in reducing mortality in severely injured patients.
• The study investigates the impact of TEP on survival in patients with significant hepatic trauma.

Purpose of the Study:

• To evaluate the effectiveness of implementing a Trauma Exsanguination Protocol (TEP) at hospital initiation of resuscitation.
• To determine if TEP improves survival rates in patients with severe hepatic trauma.
• To analyze the impact of TEP on blood product utilization and complication rates.

Main Methods:

• Retrospective study comparing patients with Grades III-V hepatic injury undergoing immediate surgery.
• Inclusion criteria: intra-abdominal hemorrhage, Grades III-V hepatic injury, immediate operative intervention.
• Comparison between a pre-TEP cohort and a post-TEP cohort (after protocol implementation in Feb 2006).
• Univariate and multivariate analyses were used to assess TEP's effect on survival and complications.

Main Results:

• The TEP cohort showed improved 30-day survival (53%) compared to the pre-TEP cohort (31%).
• TEP patients received more plasma and platelets, and less crystalloid.
• TEP was associated with significantly lower rates of cardiac dysfunction and abdominal compartment syndrome in survivors.
• Multivariate analysis confirmed TEP significantly improved 30-day survival (OR=0.22, p=0.02) after adjusting for injury severity.

Conclusions:

• Trauma Exsanguination Protocols (TEP) facilitate effective intraoperative use of plasma and platelets in severe hepatic injury.
• TEP utilization is linked to reduced cardiac dysfunction and abdominal compartment syndrome.
• Implementation of TEP significantly enhances 30-day survival rates for patients with severe hepatic trauma.