Goal-directed hemostatic resuscitation for massively bleeding patients: the Copenhagen concept.
BACKGROUND
Continued hemorrhage remains a major cause of mortality in massively transfused patients, many of whom develop coagulopathy. A review of transfusion practice for these patients at our hospital revealed that a significant proportion received suboptimal transfusion therapy. Survivors had higher platelets count than non-survivors.


METHODS
For massively transfused patients with hemodynamic instability, we introduced the concept of transfusion packages comprising five units of red blood cells, five units of fresh frozen plasma and two units of platelet concentrates. Thrombelastogram analysis was validated for routine laboratory use and implemented in the blood bank for monitoring coagulopathy and guiding transfusion therapy. Anaesthetists at our hospital were trained in functional haemostasis management based on analysis of thrombelastograms.


RESULTS
Intraoperative administration of transfusion packages for patients operated on for a ruptured abdominal aortic aneurysm was associated with a reduction in mortality from 56% to 34% (p = 0.02). When comparing massively transfused patients treated with hemostatic control resuscitation, i.e., transfusion package therapy during hemodynamic instability and thromboelastogram--monitored and guided transfusion therapy, with controls treated in accordance with existing transfusion guidelines, mortality was reduced from 31% to 20% (p = 0.002).


CONCLUSIONS
The initiative from the blood bank, i.e., transfusion packages for patients with uncontrollable bleeding and based on the thromboelastogram when hemodynamic control is established, has improved the transfusion practice and survival in massively transfused patients at our hospital.
Section for Transfusion Medicine, Capital Region Blood Bank, Rigshospitalet, University of Copenhagen, Denmark. Electronic address: per.johansson@rh.regionh.dk.
Pär I
PI
Johansson
D017544:Aortic Aneurysm, Abdominal / Q000601:surgery; D000094902:Blood Banking / Q000379:methods; D016913:Blood Component Transfusion / Q000379:methods*; D001803:Blood Transfusion / Q000401:mortality; D006470:Hemorrhage / Q000401:mortality / Q000628:therapy*; D006487:Hemostasis; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D012151:Resuscitation / Q000379:methods*; D065227:Transfusion Reaction