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Anaesthesia Critical Care & Pain Medicine
Sous presse. Epreuves corrigées par l'auteur. Disponible en ligne depuis le samedi 9 mars 2019
Doi : 10.1016/j.accpm.2019.02.005
Effects of modification of trauma bleeding management: A before and after study
 

Cécile Guth c, Olivia Vassal a, b, Arnaud Friggeri a, b, Pierre-François Wey c, Kenji Inaba d, Evelyne Decullier e, François-Xavier Ageron f, Jean-Stéphane David a, b, c,
a Department of Anaesthesiology and Critical Care Medicine, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, 69495 Pierre Benite, France 
b Université Claude Bernard Lyon 1, 69003 Lyon, France 
c Service de Santé des Armées, Hôpital d’Instruction des Armées Desgenettes, Department of Anaesthesiology and Critical Care Medicine, 69003 Lyon, France 
d Division of Trauma and Critical Care, Department of Surgery, LAC + USC Medical Center, University of Southern California, Los Angeles, California, USA 
e Pole Information Medicale Evaluation Recherche, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, 69003 Lyon, France 
f Emergency Department and SAMU 74, Annecy-Genevois Hospital, Annecy, France 

Corresponding author at: Departement d’Anesthesie-Reanimation, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69495 Pierre-Benite Cedex, France.Departement d’Anesthesie-Reanimation, Centre Hospitalier Lyon Sud, Hospices Civils de LyonPierre-Benite Cedex69495France
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.

The full text of this article is available in PDF format.

Keywords : Tranexamic acid, Thromboelastometry, Trauma, Coagulopathy, Blood products, Coagulation factor concentrates, Damage control




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