Damage Control Hematology: The Impact of a Trauma Exsanguination Protocol on Survival and Blood Product Utilization

• DOI: 10.1097/ta.0b013e31816c5c80
• Publication Date: 2008-05-05T08:10:53Z
• Authors: Bryan A. Cotton; Oliver L. Gunter; James Isbell; Brigham K. Au; Amy M. Robertson; John A. Morris; Paul St. Jacques; Pampee P. Young
• Keywords: Blood product; Fresh frozen plasma; Major trauma; Hematology

Background: The importance of early and aggressive management trauma- related coagulopathy remains poorly understood. We hypothesized that a trauma exsanguination protocol (TEP) systematically provides specified numbers types blood components immediately upon initiation resuscitation would improve survival reduce overall product consumption among the most severely injured patients. Methods: recently implemented TEP, which involves immediate continued release products from bank in predefined ratio 10 units packed red cells (PRBC) to 4 fresh frozen plasma 2 platelets. All TEP activations February 1, 2006 July 31, 2007 were retrospectively evaluated. A comparison cohort (pre-TEP) was selected all admissions between August 2004 January (1) underwent surgery by team (2) received greater than PRBC first 24 hours. Multivariable analysis performed compare mortality two groups. Results: Two hundred eleven patients met inclusion criteria (117 pre-TEP, 94 TEP). Age, sex, Injury Severity Score similar groups, whereas physiologic severity (by weighted Revised Trauma Score) predicted trauma-related Score, TRISS) worse group (p values 0.037 0.028, respectively). After controlling for age, mechanism injury, TRISS 24-hour usage, there 74% reduction odds = 0.001). Overall adjusted also significantly reduced 0.015). Conclusions: have demonstrated an protocol, delivered manner, reduces as well consumption.