title: Does saline resuscitation affect mechanisms of coagulopathy in critically ill trauma patients? An exploratory analysis.
abstract: Metabolic acidosis has been implicated in the development of coagulopathy, although the specific mechanisms have not been well characterized. We sought to explore whether resuscitation of injured patients with a balanced crystalloid solution affects coagulation, as measured by endogenous thrombin potential (ETP) and thromboelastography (TEG). We performed an exploratory analysis of a subset of subjects enrolled in a randomized trial comparing the effect of resuscitation with isotonic saline versus Plasma-Lyte A (PLA) on acidosis and electrolyte abnormalities. We collected plasma at admission and 6 h later for subsequent ETP and TEG analysis and compared subjects receiving isotonic saline to those receiving PLA. Among 18 evaluated subjects, baseline characteristics, including ETP and TEG parameters, were similar between the two arms. At 6 h, subjects receiving isotonic saline were more acidemic. At 6 h, there were no differences in ETP parameters between groups; however, TEG results showed the time from initial clot formation to an amplitude of 20 mm (K) was shorter (3.8 ± 2.1 vs. 7.2 ± 2.8 s) and the rapidity of fibrin build-up and cross-linking (α angle) was significantly greater (41 ± 8 vs. 24 ± 15 deg) for the PLA group than in the isotonic saline group. Relative to PLA, isotonic saline does not alter thrombin generation, but isotonic saline and PLA may differentially impact clotting factor availability. The shorter time to reach prespecified clot amplitude and the increased rate of fibrin generation imply faster amplification of clotting factors with PLA without effect on latency time or clot strength.
authors: Department of Surgery, Division of Trauma and Emergency Surgery, and Department of Pathology, University of California, Davis, Medical Center, Sacramento, California, USA.
authors: Caitlin A
authors: CA
authors: Smith
authors: Robert C
authors: RC
authors: Gosselin
authors: Garth H
authors: GH
authors: Utter
authors: Joseph M
authors: JM
authors: Galante
authors: Jason B
authors: JB
authors: Young
authors: Lynette A
authors: LA
authors: Scherer
authors: Carol R
authors: CR
authors: Schermer
mesh_terms: D000138:Acidosis / Q000097:blood / Q000139:chemically induced* / Q000517:prevention & control; D001780:Blood Coagulation Tests; D002712:Chlorides / Q000097:blood*; D016638:Critical Illness / Q000628:therapy*; D000077324:Crystalloid Solutions; D004311:Double-Blind Method; D004573:Electrolytes / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D005440:Fluid Therapy / Q000379:methods*; D006474:Hemorrhagic Disorders / Q000097:blood / Q000209:etiology*; D006801:Humans; D007262:Infusions, Intravenous; D007552:Isotonic Solutions / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D010952:Plasma Substitutes / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D012151:Resuscitation / Q000009:adverse effects* / Q000379:methods; D018401:Sample Size; D012771:Shock, Hemorrhagic / Q000097:blood / Q000209:etiology / Q000628:therapy*; D012965:Sodium Chloride / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D013916:Thrombelastography; D013917:Thrombin / Q000502:physiology; D014947:Wounds and Injuries / Q000150:complications / Q000628:therapy*
chemical_list: D002712:Chlorides; D000077324:Crystalloid Solutions; D004573:Electrolytes; D007552:Isotonic Solutions; D010952:Plasma Substitutes; D012965:Sodium Chloride; C048013:Plasmalyte A; D013917:Thrombin