Coagulation factor concentrate-based therapy for remote damage control resuscitation (RDCR): a reasonable...

Area of Science:

• Trauma Resuscitation
• Hemorrhagic Shock Management
• Coagulation Science

Background:

• Remote damage control resuscitation (RDCR) is an emerging field with potential to improve outcomes for critically injured patients.
• The prehospital phase is critical for minimizing shock and coagulopathy, thereby reducing morbidity and mortality.
• Optimal transfusion strategies for prehospital resuscitation remain under investigation and debate.

Purpose of the Study:

• To review the implications of recent trials, such as the pragmatic, randomize, optimal platelet, and plasma ratios trial (PROPPR), for RDCR.
• To explore alternative hemostatic resuscitation strategies for prehospital and remote settings.
• To identify key components for effective prehospital hemostasis.

Main Methods:

• Review of current literature and trial data, including PROPPR and prospective fibrinogen in trauma induced coagulopathy (FIinTIC) study.
• Discussion of an alternative approach involving early administration of coagulation factor concentrates and tranexamic acid (TXA).
• Consideration of point-of-care devices for guiding remote administration of hemostatic agents.

Main Results:

• The optimal transfusion strategy for RDCR is still debated.
• Early administration of TXA is strongly supported by evidence.
• Fibrinogen and prothrombin complex concentrates are potential agents for supporting clot formation and thrombin generation.

Conclusions:

• Identifying the appropriate transfusion strategy is crucial before widespread adoption of prehospital hemostatic resuscitation.
• A multi-component approach targeting hyperfibrinolysis, clot formation, and thrombin generation is proposed for RDCR.
• Further research is urgently needed to validate these strategies and the use of advanced monitoring and hemostatic agents in remote settings.