Hypofibrinogenemic Massive Transfusion Trauma Patients Experience Worse Outcomes

Area of Science:

• Trauma and Emergency Medicine
• Hemorrhagic Shock Management
• Coagulation and Transfusion Medicine

Background:

• Uncontrolled hemorrhage is a major cause of trauma mortality.
• Low fibrinogen levels during traumatic hemorrhage correlate with adverse outcomes.
• Current massive transfusion (MT) protocols lack defined cryoprecipitate ratios for optimal fibrinogen replacement.

Purpose of the Study:

• To investigate the impact of admission fibrinogen levels on outcomes in trauma patients undergoing MT.
• To assess the effect of cryoprecipitate administration on mortality in this patient cohort.

Main Methods:

• Prospective guideline implementation for fibrinogen level assessment in adult trauma patients undergoing MT.
• Administration of 10 units of cryoprecipitate every other MT round.
• Comparison of hypofibrinogenemic (<200 mg/dL) versus normofibrinogenemic (≥200 mg/dL) patients using thromboelastography (TEG) and outcome data.

Main Results:

• Hypofibrinogenemia (<200 mg/dL) was observed in 96/130 MT patients, associated with elevated INR and abnormal TEG parameters.
• Hypofibrinogenemic patients received more packed red blood cells (PRBCs), fresh frozen plasma (FFP), and platelets.
• Mortality was significantly higher in hypofibrinogenemic patients (50% vs. 23.5%, P = .021), with lower fibrinogen levels independently predicting mortality.

Conclusions:

• Decreased admission fibrinogen levels in trauma patients undergoing MT are associated with increased mortality.
• Higher fibrinogen levels correlate with lower mortality risk, independent of age and injury severity.
• Further research is needed to determine optimal cryoprecipitate dosing during MT to improve survival rates.