title: Induced hypothermia does not impair coagulation system in a swine multiple trauma model.
abstract: BACKGROUND
  Accidental hypothermia, acidosis, and coagulopathy represent the lethal triad in severely injured patients. Therapeutic hypothermia however is commonly used in transplantations, cardiac and neurosurgical surgery, or after cardiac arrest. However, the effects of therapeutic hypothermia on the coagulation system following multiple trauma need to be elucidated.
  
  
  METHODS
  In a porcine model of multiple trauma including blunt chest injury, liver laceration, and hemorrhagic shock followed by fluid resuscitation, the influence of therapeutic hypothermia on coagulation was evaluated. A total of 40 pigs were randomly assigned to sham (only anesthesia) or trauma groups receiving either hypothermia or normothermia. Each group consisted of 10 pigs. Analyzed parameters were cell count (red blood cells, platelets), pH, prothrombin time (PT), fibrinogen concentration, and analysis with ROTEM and Multiplate.
  
  
  RESULTS
  Trauma and consecutive fluid resuscitation resulted in impaired coagulation parameters (cell count, pH, PT, fibrinogen, ROTEM, and platelet function). During hypothermia, coagulation parameters measured at 37°C, such as PT, fibrinogen, thrombelastometry measurements, and platelet function, showed no significant differences between normothermic and hypothermic animals in both trauma groups. Additional analyses of thrombelastometry at 34°C during hypothermia showed significant differences for clotting time and clot formation time but not for maximum clot firmness. We were not able to detect macroscopic or petechial bleeding in both trauma groups.
  
  
  CONCLUSIONS
  Based on the results of the present study we suggest that mild hypothermia can be safely performed after stabilization following major trauma. Mild hypothermia has effects on the coagulation system but does not aggravate trauma-induced coagulopathy in our model. Before hypothermic treatment can be performed in the clinical setting, additional experiments with prolonged and deeper hypothermia to exclude detrimental effects are required.
authors.affiliation: Trauma Department, Hand and Reconstructive Surgery, University of Giessen-Marburg, Marburg, Germany. mohrj@med.uni-marburg.de
authors.forename: Juliane
authors.initials: J
authors.lastname: Mohr
authors.forename: Steffen
authors.initials: S
authors.lastname: Ruchholtz
authors.forename: Frank
authors.initials: F
authors.lastname: Hildebrand
authors.forename: Sascha
authors.initials: S
authors.lastname: Flohé
authors.forename: Michael
authors.initials: M
authors.lastname: Frink
authors.forename: Ingo
authors.initials: I
authors.lastname: Witte
authors.forename: Matthias
authors.initials: M
authors.lastname: Weuster
authors.forename: Matthias
authors.initials: M
authors.lastname: Fröhlich
authors.forename: Martijn
authors.initials: M
authors.lastname: van Griensven
authors.forename: Claudia
authors.initials: C
authors.lastname: Keibl
authors.forename: Philipp
authors.initials: P
authors.lastname: Mommsen
mesh_terms: D000818:Animals; D001777:Blood Coagulation / Q000502:physiology*; D001778:Blood Coagulation Disorders / Q000097:blood* / Q000209:etiology / Q000628:therapy; D001780:Blood Coagulation Tests; D004195:Disease Models, Animal; D007036:Hypothermia, Induced; D008297:Male; D009104:Multiple Trauma / Q000097:blood / Q000150:complications / Q000628:therapy*; D013552:Swine