Cécile Guth1, Olivia Vassal2, Arnaud Friggeri2, Pierre-François Wey1, Kenji Inaba3, Evelyne Decullier4, François-Xavier Ageron5, Jean-Stéphane David6. 1. Service de Santé des Armées, Hôpital d'Instruction des Armées Desgenettes, Department of Anaesthesiology and Critical Care Medicine, 69003 Lyon, France. 2. Department of Anaesthesiology and Critical Care Medicine, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, 69495 Pierre Benite, France; Université Claude Bernard Lyon 1, 69003 Lyon, France. 3. Division of Trauma and Critical Care, Department of Surgery, LAC + USC Medical Center, University of Southern California, Los Angeles, California, USA. 4. Pole Information Medicale Evaluation Recherche, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, 69003 Lyon, France. 5. Emergency Department and SAMU 74, Annecy-Genevois Hospital, Annecy, France. 6. Department of Anaesthesiology and Critical Care Medicine, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, 69495 Pierre Benite, France; Université Claude Bernard Lyon 1, 69003 Lyon, France; Service de Santé des Armées, Hôpital d'Instruction des Armées Desgenettes, Department of Anaesthesiology and Critical Care Medicine, 69003 Lyon, France. Electronic address: js-david@univ-lyon1.fr.
Abstract
OBJECTIVE: We hypothesised that the association of tranexamic acid (TXA) administration and thromboelastometry-guided haemostatic therapy (TGHT) with implementation of Damage Control Resuscitation (DCR) reduced blood products (BP) use and massive transfusion (MT). METHODS: Retrospective comparison of 2 cohorts of trauma patients admitted in a university hospital, before (Period 1) and after implementation of DCR, TXA (first 3-hours) and TGHT (Period 2). Patients were included if they received at least 1 BP (RBC, FFP or platelet) or coagulation factor concentrates (fibrinogen or prothrombin complex) during the first 24-hours following the admission. RESULTS: 380 patients were included. Patients in Period 2 (n = 182) received less frequently a MT (8% vs. 33%, P < 0.01), significantly less BP (RBC: 2 units [1-5] vs. 6 [3-11]; FFP: 0 units [0-2] vs. 4 [2-8]) but more fibrinogen concentrates (3.0 g [1.5-4.5] vs. 0.0 g [0.0-3.0], P < 0.01). Multivariate logistic regression analysis identified Period 1 as being associated with an increased risk of receiving MT (OR: 26.1, 95% CI: 9.7-70.2) and decreased survival at 28 days (OR: 2.0, 95% CI: 1.0-3.9). After propensity matching, the same results were observed but there was no difference for survival and a significant decrease for the cost of BP (2370 ± 2126 vs. 3284 ± 3812 €, P: 0.036). CONCLUSION: Following the implementation of a bundle of care including DCR, TGHT and administration of TXA, we observed a decrease to the use of blood products, need for MT and an improvement of survival.
OBJECTIVE: We hypothesised that the association of tranexamic acid (TXA) administration and thromboelastometry-guided haemostatic therapy (TGHT) with implementation of Damage Control Resuscitation (DCR) reduced blood products (BP) use and massive transfusion (MT). METHODS: Retrospective comparison of 2 cohorts of traumapatients admitted in a university hospital, before (Period 1) and after implementation of DCR, TXA (first 3-hours) and TGHT (Period 2). Patients were included if they received at least 1 BP (RBC, FFP or platelet) or coagulation factor concentrates (fibrinogen or prothrombin complex) during the first 24-hours following the admission. RESULTS: 380 patients were included. Patients in Period 2 (n = 182) received less frequently a MT (8% vs. 33%, P < 0.01), significantly less BP (RBC: 2 units [1-5] vs. 6 [3-11]; FFP: 0 units [0-2] vs. 4 [2-8]) but more fibrinogen concentrates (3.0 g [1.5-4.5] vs. 0.0 g [0.0-3.0], P < 0.01). Multivariate logistic regression analysis identified Period 1 as being associated with an increased risk of receiving MT (OR: 26.1, 95% CI: 9.7-70.2) and decreased survival at 28 days (OR: 2.0, 95% CI: 1.0-3.9). After propensity matching, the same results were observed but there was no difference for survival and a significant decrease for the cost of BP (2370 ± 2126 vs. 3284 ± 3812 €, P: 0.036). CONCLUSION: Following the implementation of a bundle of care including DCR, TGHT and administration of TXA, we observed a decrease to the use of blood products, need for MT and an improvement of survival.
Authors: Cyril Pernod; Laurie Fraticelli; Guillaume Marcotte; Bernard Floccard; Thibaut Girardot; Clement Claustre; Carlos El Khoury; Thomas Rimmele Journal: Turk J Anaesthesiol Reanim Date: 2021-10