Effect of Haemostatic Control Resuscitation on mortality in massively bleeding patients: a before and after study

Abstract

Background and Objectives Evidence supporting the use of platelets and plasma in resuscitation of massive bleedings is questionable. Current consensus guidelines recommend restrictive use. Our aim was to determine the effect of changing the transfusion practice on 30‐day survival in massively bleeding patients. Materials and Methods Consecutive adult patients receiving more than 10 units of red blood cells (RBC) within 24 h 2 years prior to (2002–2003) and 2 years after (2005–2006) a change in transfusion practice were included. In 2004, we implemented Haemostatic Control Resuscitation (HCR) with preemptive use of platelets and plasma, administered in transfusion packages, comprising 5 units of RBCs, 5 units of fresh‐frozen plasma and 2 units of platelet concentrates (PC), when massive bleeding occurred or upon arrival at the emergency room and thereafter directed by thrombelastography throughout the peri‐ and postoperative period. Results In 2005–2006, the 442 patients received more PCs within 24 h from admission [mean 5·0 (SD 4·2) vs. 1·7 (2·0); P < 0·0001] and had a smaller decrease in platelet count during the bleeding episode [91·5 (81·2) vs. 119·7 (100·8) × 10 9 /l; P = 0·0025] than the 390 patients treated in 2002–2003. Thirty‐day mortality was reduced in 2005–2006 (20·4% vs. 31·5%; P = 0·0002) and at 90‐day (22·4% vs. 34·6%; P < 0·0001) as compared to 2002–2003. Conclusions In patients who experience massive bleeding, HCR with platelets and plasma, as guided by thrombelastography, is associated with improved survival. While confirmation from a randomized controlled trial is urgently needed, HCR may be considered in these patients.

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• The European guideline on management of major bleeding and coagulopathy following trauma: fourth edition · 2016
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• A general review of major global coagulation assays: thrombelastography, thrombin generation test and clot waveform analysis · 2015
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• Management of bleeding and coagulopathy following major trauma: an updated European guideline · 2013
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• Early and individualized goal-directed therapy for trauma-induced coagulopathy · 2012
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• Clinical effectiveness of fresh frozen plasma compared with fibrinogen concentrate: a systematic review · 2011
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• FIBTEM provides early prediction of massive transfusion in trauma · 2011
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• Management of bleeding following major trauma: an updated European guideline · 2010
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• Thrombelastography and tromboelastometry in assessing coagulopathy in trauma · 2009
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