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The "coagulation box" and a new hemoglobin-driven algorithm for bleeding control in patients with severe multiple
Peter Hilbert1, Gunther Olaf Hofmann2, Jörg Teichmann3
1Department of Anesthesiology, Intensive Care and Emergency Medicine, BG-Kliniken Bergmannstrost, Halle, Germany.
Archives of Trauma Research
|January 8, 2014
Summary
An Hb-driven algorithm guides early clotting therapy in trauma patients, improving outcomes. This approach utilizes readily available hemoglobin levels to initiate treatment, potentially reducing mortality from hemorrhage.
Area of Science:
- Trauma Care
- Hemorrhage Management
- Coagulation Disorders
Background:
- Extensive hemorrhage is a leading cause of early death in multiple trauma patients.
- Timely intervention for clotting disorders is crucial for reducing mortality.
- Hemoglobin (Hb) levels offer a rapid assessment compared to delayed coagulation studies.
Purpose of the Study:
- To evaluate an Hb-driven algorithm for guiding initial clotting therapy in multiple trauma patients.
- To assess the efficacy of early intervention using specific clotting factors and blood products.
Main Methods:
- Development of a three-step Hb-driven algorithm for aggressive clotting therapy.
- Utilization of a "coagulation box" for immediate access to fibrinogen, PCC, factor VIIa, tranexamic acid, and desmopressin.
- Transfusion strategy with an RBC-to-FFP ratio of 2:1 to 1:1.
Main Results:
- 123 severe trauma patients were included; 25 were treated with the "coagulation box" algorithm.
- Patients receiving the algorithm treatment showed marked improvement in clotting parameters.
- Survival rate for the algorithm group was 64%, exceeding the predicted survival rate (41%).
Conclusions:
- An Hb-driven algorithm combined with early clotting factor administration is a simple and effective strategy.
- The "coagulation box" facilitates rapid treatment initiation for coagulopathy in trauma.
- This approach shows potential for improving survival rates in multiple trauma patients.
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