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Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học quốc tế cung cấp cho các bạn kiến thức về ngành y đề tài: Goal-directed coagulation management of major trauma patients using thromboelastometry (ROTEM®)-guided administration of fibrinogen . | Schõchl et al. Critical Care 2010 14 R55 http ccforum.eom content 14 2 R55 c CRITICAL CARE RESEARCH Open Access Goal-directed coagulation management of major trauma patients using thromboelastometry ROTEM -guided administration of fibrinogen concentrate and prothrombin complex concentrate Herbert Schõchl1 2 Ulrike Nienaber3 Georg Hofer1 Wolfgang Voelckel1 Csilla Jambor4 Gisela Scharbert5 Sibylle Kozek-Langenecker5 and Cristina Solomon 6 Abstract Introduction The appropriate strategy for trauma-induced coagulopathy management is under debate. We report the treatment of major trauma using mainly coagulation factor concentrates. Methods This retrospective analysis included trauma patients who received 5 units of red blood cell concentrate within 24 hours. Coagulation management was guided by thromboelastometry ROTEM . Fibrinogen concentrate was given as first-line haemostatic therapy when maximum clot firmness MCF measured by FibTEM fibrin-based test was 10 mm. Prothrombin complex concentrate PCC was given in case of recent coumarin intake or clotting time measured by extrinsic activation test EXTEM 1.5 times normal. Lack of improvement in EXTEM MCF after fibrinogen concentrate administration was an indication for platelet concentrate. The observed mortality was compared with the mortality predicted by the trauma injury severity score TRISS and by the revised injury severity classification RISC score. Results Of 131 patients included 128 received fibrinogen concentrate as first-line therapy 98 additionally received PCC while 3 patients with recent coumarin intake received only PCC. Twelve patients received FFP and 29 received platelet concentrate. The observed mortality was 24.4 lower than the TRISS mortality of 33.7 P 0.032 and the RISC mortality of 28.7 P 0.05 . After excluding 17 patients with traumatic brain injury the difference in mortality was 14 observed versus 27.8 predicted by TRISS P 0.0018 and 24.3 predicted by RISC P 0.014 . Conclusions ROTEM -guided .
