title: Damage control resuscitation using blood component therapy in standard doses has a limited effect on coagulopathy during trauma hemorrhage.
abstract: OBJECTIVE
  To determine the effectiveness of blood component therapy in the correction of trauma-induced coagulopathy during hemorrhage.
  
  
  BACKGROUND
  Severe hemorrhage remains a leading cause of mortality in trauma. Damage control resuscitation strategies target trauma-induced coagulopathy (TIC) with the early delivery of high-dose blood components such as fresh frozen plasma (FFP) and platelet transfusions. However, the ability of these products to correct TIC during hemorrhage and resuscitation is unknown.
  
  
  METHODS
  This was an international prospective cohort study of bleeding trauma patients at three major trauma centers. A blood sample was drawn immediately on arrival and after 4, 8 and 12 packed red blood cell (PRBC) transfusions. FFP, platelet and cryoprecipitate use was recorded during these intervals. Samples were analyzed for functional coagulation and procoagulant factor levels.
  
  
  RESULTS
  One hundred six patients who received at least four PRBC units were included. Thirty-four patients (32 %) required a massive transfusion. On admission 40 % of patients were coagulopathic (ROTEM CA5 ≤ 35 mm). This increased to 58 % after four PRBCs and 81 % after eight PRBCs. On average all functional coagulation parameters and procoagulant factor concentrations deteriorated during hemorrhage. There was no clear benefit to high-dose FFP therapy in any parameter. Only combined high-dose FFP, cryoprecipitate and platelet therapy with a high total fibrinogen load appeared to produce a consistent improvement in coagulation.
  
  
  CONCLUSIONS
  Damage control resuscitation with standard doses of blood components did not consistently correct trauma-induced coagulopathy during hemorrhage. There is an important opportunity to improve TIC management during damage control resuscitation.
authors.affiliation: Centre for Trauma Sciences, Blizard Institute, Barts and the London School of Medicine, Queen Mary University of London, London, UK, sirat.khan@bartshealth.nhs.uk.
authors.forename: Sirat
authors.initials: S
authors.lastname: Khan
authors.forename: Ross
authors.initials: R
authors.lastname: Davenport
authors.forename: Imran
authors.initials: I
authors.lastname: Raza
authors.forename: Simon
authors.initials: S
authors.lastname: Glasgow
authors.forename: Henry D
authors.initials: HD
authors.lastname: De'Ath
authors.forename: Pär I
authors.initials: PI
authors.lastname: Johansson
authors.forename: Nicola
authors.initials: N
authors.lastname: Curry
authors.forename: Simon
authors.initials: S
authors.lastname: Stanworth
authors.forename: Christine
authors.initials: C
authors.lastname: Gaarder
authors.forename: Karim
authors.initials: K
authors.lastname: Brohi
mesh_terms: D000328:Adult; D001778:Blood Coagulation Disorders / Q000097:blood / Q000209:etiology / Q000628:therapy*; D016913:Blood Component Transfusion / Q000009:adverse effects / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D006470:Hemorrhage / Q000097:blood / Q000150:complications / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012151:Resuscitation / Q000379:methods*; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000097:blood / Q000150:complications* / Q000628:therapy; D055815:Young Adult