title: Rotational thromboelastometry analysis and management of life-threatening haemorrhage in isolated craniofacial injury.
abstract: Massive haemorrhage from facial fractures is rare but the associated mortality rate is high. Here, we describe a case in which thromboelastometry [rotational thromboelastometry (ROTEM)]-guided administration of prothrombin complex concentrate and fibrinogen concentrate was effective in correcting coagulopathy in a 68-year-old man with serious craniofacial trauma and massive haemorrhage. The patient, a cyclist who collided with a car, was transferred to the emergency department of our hospital with signs of shock and significant bleeding from multiple fractures and soft tissue injuries to the face. Blood gas analysis and standard laboratory tests revealed the presence of anaemia and acidosis, and our massive haemorrhage protocol was initiated. E-FAST and total-body computed tomography scans excluded the possibility of bleeding from other sites. All efforts were directed towards stopping bleeding from craniofacial lesions, but the surgeon experienced difficulty in maintaining haemostasis. ROTEM analysis revealed severe coagulopathy and was indispensable in guiding transfusion: 2 g tranexamic acid, followed by 1000 IU prothrombin complex concentrate, 5 g fibrinogen and 2 U platelet concentrate. Two hours later, ROTEM analysis showed that coagulopathy had been corrected, and haemostasis was confirmed by cessation of bleeding. This report highlights the potential for using ROTEM to guide treatment with fibrinogen and prothrombin complex concentrates in the presence of profuse multifocal bleeding and severe coagulopathy.
authors.affiliation: UOC Anestesia e Rianimazione, Dipartimento di Emergenza Urgenza, Ospedale dell'Angelo di Mestre, Venice, Italy. alberto.grassetto@gmail.com
authors.forename: Alberto
authors.initials: A
authors.lastname: Grassetto
authors.forename: Debora
authors.initials: D
authors.lastname: Saggioro
authors.forename: Paolo
authors.initials: P
authors.lastname: Caputo
authors.forename: Daniele
authors.initials: D
authors.lastname: Penzo
authors.forename: Antonio
authors.initials: A
authors.lastname: Bossi
authors.forename: Massimo
authors.initials: M
authors.lastname: Tedesco
authors.forename: Carlo
authors.initials: C
authors.lastname: Maggiolo
mesh_terms: D000368:Aged; D001779:Blood Coagulation Factors / Q000008:administration & dosage; D016913:Blood Component Transfusion; D001784:Blood Gas Analysis; D001792:Blood Platelets; D005151:Facial Injuries / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D005340:Fibrinogen / Q000008:administration & dosage; D020197:Head Injuries, Penetrating / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D020198:Intracranial Hemorrhage, Traumatic / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D008297:Male; D011859:Radiography; D017695:Soft Tissue Injuries / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D013916:Thrombelastography / Q000379:methods*; D014148:Tranexamic Acid / Q000008:administration & dosage
chemical_list: D001779:Blood Coagulation Factors; C025667:prothrombin complex concentrates; D014148:Tranexamic Acid; D005340:Fibrinogen