Thromboelastography in Orthopaedic Trauma Acute Pelvic Fracture Resuscitation: A Descriptive Pilot Study.

Abstract

OBJECTIVES:

To describe the adjunctive use of thromboelastography (TEG) in directing initial blood component therapy resuscitation of patients with polytrauma with acute pelvic/acetabular fractures.

DESIGN:

Retrospective cohort review.

SETTING:

Level-2 trauma center.

PATIENTS:

Forty adult trauma activations with acute pelvic and/or acetabular fractures were treated with standard fracture care and TEG with adjuvant platelet mapping (TEG/PM) analysis to guide their initial 24-hour resuscitation.

INTERVENTION:

TEG with PM provided goal-directed hemostatic resuscitation using component blood products and an established hospital transfusion protocol. Transfusions were triggered by abnormal TEG/PM results and/or the presence of active hemorrhage, persistent hemorrhagic shock, and abnormal base deficit levels.

MAIN OUTCOME MEASUREMENT:

The correction of trauma-induced coagulopathy was determined by the return of a normal TEG/PM tracing. The numbers of component blood products transfused in the first 24 hours using TEG/PM were calculated. Subgroup analysis of transfusion requirements and differences between pelvic ring and acetabular fracture patterns were determined.

RESULTS:

More than 90% of patients received a transfusion of at least 1 blood product with 84% of transfusions occurring within 6 hours of admission. TEG/PM-guided resuscitation yielded greater volumes of platelets and packed red blood cells (PRBCs) versus fresh frozen plasma (FFP) (P = 0.018) with an average transfusion ratio of 2.5:1:2.8 (PRBC:FFP:platelet). There was a trend toward greater transfusion requirements in combined injuries versus pelvic ring or acetabular fractures (P = 0.08).

CONCLUSION:

TEG with PM is a valuable adjunct to guide the acute phase of resuscitation in patients with polytrauma with pelvic injuries because it allows a real-time assessment of the coagulation status. The routine use of TEG/PM may result in transfusion ratios of blood products different from those of the current empiric 1:1:1 guidelines.

LEVEL OF EVIDENCE:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

• Authors: Christiaan N Mamczak, Megan Maloney, Braxton Fritz, Bryan Boyer, Scott Thomas, Ed Evans, Victoria A Ploplis, Francis J Castellino, Jonathon McCollester, Mark Walsh
• Journal: Journal of orthopaedic trauma (J Orthop Trauma) Vol. 30 Issue 6 Pg. 299-305 (Jun 2016) ISSN: 1531-2291 [Electronic] United States
• PMID: 27206253 (Publication Type: Journal Article)

Topics

• Acetabulum (injuries, surgery)
• Acute Disease
• Adolescent
• Adult
• Blood Component Transfusion (methods)
• Blood Transfusion (methods)
• Cohort Studies
• Combined Modality Therapy
• Female
• Follow-Up Studies
• Fracture Fixation (adverse effects, methods)
• Fractures, Bone (diagnosis, therapy)
• Humans
• Injury Severity Score
• Male
• Middle Aged
• Multiple Trauma (diagnosis, therapy)
• Pelvic Bones (injuries, surgery)
• Pilot Projects
• Resuscitation (methods)
• Retrospective Studies
• Risk Assessment
• Thrombelastography (methods)
• Transfusion Reaction
• Trauma Centers
• Treatment Outcome
• Young Adult