Kazuhiro Sugiyama1, Hiroshi Fujita2, Shigeko Nishimura2. 1. Tertiary Emergency Medical Centre, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan. 2. Department of Transfusion Medicine, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan.
Abstract
BACKGROUND: Hypofibrinogenaemia is a common complication of multiple trauma with severe traumatic brain injury (Abbreviated Injury Scale score of the head ≥4; body ≥3). In Japan, neither fibrinogen concentrate nor cryoprecipitate is permitted to treat acquired hypofibrinogenaemia with the purpose of rapidly restoring a haemostatic level of fibrinogen. The aim of this study was to investigate transfusion usage and mortality in patients with multiple trauma and severe traumatic brain injury who were given a cryoprecipitate prepared in-house, comparing those administered the product early or later. MATERIAL AND METHODS: We prepared and produced cryoprecipitate from fresh-frozen plasma beginning in March 2013. We performed a retrospective cohort study of patients admitted to our single tertiary medical centre with severe multiple trauma with traumatic brain injury from March 2013 to June 2018, sorting them into those given the cryoprecipitate infusion within 90 minutes of admission (Early group) and those given it more than 90 minutes after admission (Late group). Clinical outcomes were compared between the two groups using chi-square or Fisher's exact tests and the Wilcoxon test as appropriate. RESULTS: There were 26 and 16 patients in the Early and Late groups, respectively. The 24-hour mortality tended to be lower in the Early group than in the Late group (8 vs 13%, respectively). The patients were more severely anaemic and thrombocytopenic after haemostatic therapy in the Late group than in the Early group. Transfusion usage in the Early group was lower than that in the Late group (red blood cells: 7±1 units vs 17±3 units, p<0.05; fresh-frozen plasma: 9±1 units vs 16±3 units, p<0.05; platelet concentrate: 3±1 units vs 15±4 units, p<0.05, respectively). DISCUSSION: Early administration of an in-house cryoprecipitate may reduce transfusion usage in patients with multiple trauma with severe traumatic brain injury.
BACKGROUND: Hypofibrinogenaemia is a common complication of multiple trauma with severe traumatic brain injury (Abbreviated Injury Scale score of the head ≥4; body ≥3). In Japan, neither fibrinogen concentrate nor cryoprecipitate is permitted to treat acquired hypofibrinogenaemia with the purpose of rapidly restoring a haemostatic level of fibrinogen. The aim of this study was to investigate transfusion usage and mortality in patients with multiple trauma and severe traumatic brain injury who were given a cryoprecipitate prepared in-house, comparing those administered the product early or later. MATERIAL AND METHODS: We prepared and produced cryoprecipitate from fresh-frozen plasma beginning in March 2013. We performed a retrospective cohort study of patients admitted to our single tertiary medical centre with severe multiple trauma with traumatic brain injury from March 2013 to June 2018, sorting them into those given the cryoprecipitate infusion within 90 minutes of admission (Early group) and those given it more than 90 minutes after admission (Late group). Clinical outcomes were compared between the two groups using chi-square or Fisher's exact tests and the Wilcoxon test as appropriate. RESULTS: There were 26 and 16 patients in the Early and Late groups, respectively. The 24-hour mortality tended to be lower in the Early group than in the Late group (8 vs 13%, respectively). The patients were more severely anaemic and thrombocytopenic after haemostatic therapy in the Late group than in the Early group. Transfusion usage in the Early group was lower than that in the Late group (red blood cells: 7±1 units vs 17±3 units, p<0.05; fresh-frozen plasma: 9±1 units vs 16±3 units, p<0.05; platelet concentrate: 3±1 units vs 15±4 units, p<0.05, respectively). DISCUSSION: Early administration of an in-house cryoprecipitate may reduce transfusion usage in patients with multiple trauma with severe traumatic brain injury.
Authors: James Winearls; Don Campbell; Catherine Hurn; Jeremy Furyk; Glenn Ryan; Melita Trout; James Walsham; Anthony Holley; Megan Shuttleworth; Wayne Dyer; Gerben Keijzers; Jeff Presneill; John F Fraser; Martin Wullschleger Journal: Injury Date: 2016-12-26 Impact factor: 2.586
Authors: Melissa M Cushing; Meghann M Fitzgerald; Rebecca M Harris; Lars M Asmis; Thorsten Haas Journal: Transfusion Date: 2017-07-21 Impact factor: 3.157
Authors: Anirban Banerjee; Christopher C Silliman; Ernest E Moore; Monika Dzieciatkowska; Marguerite Kelher; Angela Sauaia; Kenneth Jones; Michael P Chapman; Eduardo Gonzalez; Hunter B Moore; Angelo D'Alessandro; Erik Peltz; Benjamin E Huebner; Peter Einerson; James Chandler; Arsen Ghasabayan; Kirk Hansen Journal: J Trauma Acute Care Surg Date: 2018-06 Impact factor: 3.313
Authors: N Curry; C Rourke; R Davenport; S Beer; L Pankhurst; A Deary; H Thomas; C Llewelyn; L Green; H Doughty; G Nordmann; K Brohi; S Stanworth Journal: Br J Anaesth Date: 2015-05-19 Impact factor: 9.166
Authors: Andrew J Webb; Caitlin S Brown; Ryan M Naylor; Alejandro A Rabinstein; Kristin C Mara; Andrea M Nei Journal: Neurocrit Care Date: 2021-04-12 Impact factor: 3.210
Authors: Seif Tarek El-Swaify; Mazen A Refaat; Sara H Ali; Abdelrahman E Mostafa Abdelrazek; Pavly Wagih Beshay; Menna Kamel; Bassem Bahaa; Abdelrahman Amir; Ahmed Kamel Basha Journal: Trauma Surg Acute Care Open Date: 2022-01-05
Authors: Zachary A Matthay; Zane J Hellmann; Rachael A Callcut; Ellicott C Matthay; Brenda Nunez-Garcia; William Duong; Jeffry Nahmias; Aimee K LaRiccia; M Chance Spalding; Satya S Dalavayi; Jessica K Reynolds; Heather Lesch; Yee M Wong; Amanda M Chipman; Rosemary A Kozar; Liz Penaloza; Kaushik Mukherjee; Khaled Taghlabi; Christopher A Guidry; Sirivan S Seng; Asanthi Ratnasekera; Amirreza Motameni; Pascal Udekwu; Kathleen Madden; Sarah A Moore; Jordan Kirsch; Jesse Goddard; James Haan; Kelly Lightwine; Julianne B Ontengco; Daniel C Cullinane; Sarabeth A Spitzer; John C Kubasiak; Joshua Gish; Joshua P Hazelton; Alexandria Z Byskosh; Joseph A Posluszny; Erin E Ross; John J Park; Brittany Robinson; Mary Kathryn Abel; Alexander T Fields; Jonathan H Esensten; Ashok Nambiar; Joanne Moore; Claire Hardman; Pranaya Terse; Xian Luo-Owen; Anquonette Stiles; Brenden Pearce; Kimberly Tann; Khaled Abdul Jawad; Gabriel Ruiz; Lucy Z Kornblith Journal: J Trauma Acute Care Surg Date: 2021-07-01 Impact factor: 3.697