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Karim Brohi - One of the best experts on this subject based on the ideXlab platform.
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Damage control resuscitation using Blood Component Therapy in standard doses has a limited effect on coagulopathy during trauma hemorrhage
Intensive Care Medicine, 2015Co-Authors: S Khan, Ross Davenport, Imran Raza, Simon Glasgow, Henry D. De’ath, Pär I. Johansson, Nicola Curry, Simon J. Stanworth, Christine Gaarder, Karim BrohiAbstract: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.
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Damage control resuscitation using Blood Component Therapy in standard doses has a limited effect on coagulopathy during trauma hemorrhage
Intensive care medicine, 2014Co-Authors: S Khan, Ross Davenport, Imran Raza, Simon Glasgow, Henry D. De’ath, Pär I. Johansson, Nicola Curry, Simon J. Stanworth, Christine Gaarder, Karim BrohiAbstract:Objective To determine the effectiveness of Blood Component Therapy in the correction of trauma-induced coagulopathy during hemorrhage.
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A major haemorrhage protocol improves the delivery of Blood Component Therapy and reduces waste in trauma massive transfusion
Injury, 2012Co-Authors: S Khan, Ross Davenport, Shubha Allard, Anne Weaver, Colin Barber, Karim BrohiAbstract:Abstract Background Major haemorrhage protocols (MHP) are required as part of damage control resuscitation regimens in modern trauma care. The primary objectives of this study were to ascertain whether a MHP improved Blood product administration and reduced waste compared to traditional massive transfusion protocols (MTP). Methods Datasets on adult trauma admissions 1 year prior and 1 year post implementation of a MHP at a Level 1 trauma centre were obtained from the trauma registry. Demographic and clinical data were collected prospectively including mechanism of injury, physiological observations, ICU admission and length of stay. The volume of Blood Components (packed red Blood cells, platelets, cryoprecipitate and fresh frozen plasma) issued, transfused, returned to stock and wasted within the first 24 h was gathered retrospectively. Results Over the 2-year study period 2986 patient records were available for analysis. 40 patients required a 10+ Units of packed red Blood ells transfusion in the MTP group vs. 56 patients post MHP implementation. The administration of Blood Component Therapy improved significantly post MHP implementation. FFP:PRBC transfusion improved from 1:3 to 1:2 (p Conclusion Implementation of a MHP results in improved delivery of Blood Components and a reduction in the waste of Blood products compared to the older model of MTP. In combination with educational programmes MHP can significantly improve Blood product administration and patient outcomes in trauma haemorrhage. Level of evidence Level III diagnostic test study.
Simon J. Stanworth - One of the best experts on this subject based on the ideXlab platform.
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Damage control resuscitation using Blood Component Therapy in standard doses has a limited effect on coagulopathy during trauma hemorrhage
Intensive Care Medicine, 2015Co-Authors: S Khan, Ross Davenport, Imran Raza, Simon Glasgow, Henry D. De’ath, Pär I. Johansson, Nicola Curry, Simon J. Stanworth, Christine Gaarder, Karim BrohiAbstract: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.
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Damage control resuscitation using Blood Component Therapy in standard doses has a limited effect on coagulopathy during trauma hemorrhage
Intensive care medicine, 2014Co-Authors: S Khan, Ross Davenport, Imran Raza, Simon Glasgow, Henry D. De’ath, Pär I. Johansson, Nicola Curry, Simon J. Stanworth, Christine Gaarder, Karim BrohiAbstract:Objective To determine the effectiveness of Blood Component Therapy in the correction of trauma-induced coagulopathy during hemorrhage.
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The desperate need for good-quality clinical trials to evaluate the optimal source and dose of fibrinogen in managing bleeding
Critical Care, 2011Co-Authors: Simon J. Stanworth, Beverley J HuntAbstract:Recent interest in transfusion management of trauma patients has heightened expectation in the role of Blood Component Therapy in improving patient outcome. Optimal transfusion support in supplementation with fibrinogen has not been defined by high-quality evidence. Current evidence comes mainly from case series and uncontrolled studies and does not support the superiority of one source of fibrinogen over another or the optimal schedule or dose for patient benefit. There are unanswered questions about safety, especially the effects on the risk of hospital-acquired venous thromboembolism, an important consideration in any Therapy that alters the hemostatic balance. Studies of cost-effectiveness have not been considered in research. An international move to supplement fibrinogen more 'aggressively' without direct clinical evaluation beforehand represents a failed opportunity to improve our very limited understanding of optimal transfusion practice.
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Red Blood cell transfusion in neonates.
PEDIATRICS, 2005Co-Authors: Neil A Murray, Irene Roberts, Simon J. StanworthAbstract:To the Editor.— Bell et al1 are to be congratulated for conducting and reporting their recent trial comparing the effects of restrictive and liberal thresholds for red Blood cell transfusion in preterm neonates. Such patients receive large amounts of Blood-Component Therapy, but despite considerable research in this patient group, virtually all Blood-Component Therapy in preterm neonates remains opinion based rather than truly evidence based. Thus, any well-conducted research into the potential benefits and risks of Blood Components in preterm neonates must be welcomed with open arms. The critical …
S Khan - One of the best experts on this subject based on the ideXlab platform.
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Damage control resuscitation using Blood Component Therapy in standard doses has a limited effect on coagulopathy during trauma hemorrhage
Intensive Care Medicine, 2015Co-Authors: S Khan, Ross Davenport, Imran Raza, Simon Glasgow, Henry D. De’ath, Pär I. Johansson, Nicola Curry, Simon J. Stanworth, Christine Gaarder, Karim BrohiAbstract: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.
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Damage control resuscitation using Blood Component Therapy in standard doses has a limited effect on coagulopathy during trauma hemorrhage
Intensive care medicine, 2014Co-Authors: S Khan, Ross Davenport, Imran Raza, Simon Glasgow, Henry D. De’ath, Pär I. Johansson, Nicola Curry, Simon J. Stanworth, Christine Gaarder, Karim BrohiAbstract:Objective To determine the effectiveness of Blood Component Therapy in the correction of trauma-induced coagulopathy during hemorrhage.
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A major haemorrhage protocol improves the delivery of Blood Component Therapy and reduces waste in trauma massive transfusion
Injury, 2012Co-Authors: S Khan, Ross Davenport, Shubha Allard, Anne Weaver, Colin Barber, Karim BrohiAbstract:Abstract Background Major haemorrhage protocols (MHP) are required as part of damage control resuscitation regimens in modern trauma care. The primary objectives of this study were to ascertain whether a MHP improved Blood product administration and reduced waste compared to traditional massive transfusion protocols (MTP). Methods Datasets on adult trauma admissions 1 year prior and 1 year post implementation of a MHP at a Level 1 trauma centre were obtained from the trauma registry. Demographic and clinical data were collected prospectively including mechanism of injury, physiological observations, ICU admission and length of stay. The volume of Blood Components (packed red Blood cells, platelets, cryoprecipitate and fresh frozen plasma) issued, transfused, returned to stock and wasted within the first 24 h was gathered retrospectively. Results Over the 2-year study period 2986 patient records were available for analysis. 40 patients required a 10+ Units of packed red Blood ells transfusion in the MTP group vs. 56 patients post MHP implementation. The administration of Blood Component Therapy improved significantly post MHP implementation. FFP:PRBC transfusion improved from 1:3 to 1:2 (p Conclusion Implementation of a MHP results in improved delivery of Blood Components and a reduction in the waste of Blood products compared to the older model of MTP. In combination with educational programmes MHP can significantly improve Blood product administration and patient outcomes in trauma haemorrhage. Level of evidence Level III diagnostic test study.
Ross Davenport - One of the best experts on this subject based on the ideXlab platform.
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Damage control resuscitation using Blood Component Therapy in standard doses has a limited effect on coagulopathy during trauma hemorrhage
Intensive Care Medicine, 2015Co-Authors: S Khan, Ross Davenport, Imran Raza, Simon Glasgow, Henry D. De’ath, Pär I. Johansson, Nicola Curry, Simon J. Stanworth, Christine Gaarder, Karim BrohiAbstract: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.
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Damage control resuscitation using Blood Component Therapy in standard doses has a limited effect on coagulopathy during trauma hemorrhage
Intensive care medicine, 2014Co-Authors: S Khan, Ross Davenport, Imran Raza, Simon Glasgow, Henry D. De’ath, Pär I. Johansson, Nicola Curry, Simon J. Stanworth, Christine Gaarder, Karim BrohiAbstract:Objective To determine the effectiveness of Blood Component Therapy in the correction of trauma-induced coagulopathy during hemorrhage.
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A major haemorrhage protocol improves the delivery of Blood Component Therapy and reduces waste in trauma massive transfusion
Injury, 2012Co-Authors: S Khan, Ross Davenport, Shubha Allard, Anne Weaver, Colin Barber, Karim BrohiAbstract:Abstract Background Major haemorrhage protocols (MHP) are required as part of damage control resuscitation regimens in modern trauma care. The primary objectives of this study were to ascertain whether a MHP improved Blood product administration and reduced waste compared to traditional massive transfusion protocols (MTP). Methods Datasets on adult trauma admissions 1 year prior and 1 year post implementation of a MHP at a Level 1 trauma centre were obtained from the trauma registry. Demographic and clinical data were collected prospectively including mechanism of injury, physiological observations, ICU admission and length of stay. The volume of Blood Components (packed red Blood cells, platelets, cryoprecipitate and fresh frozen plasma) issued, transfused, returned to stock and wasted within the first 24 h was gathered retrospectively. Results Over the 2-year study period 2986 patient records were available for analysis. 40 patients required a 10+ Units of packed red Blood ells transfusion in the MTP group vs. 56 patients post MHP implementation. The administration of Blood Component Therapy improved significantly post MHP implementation. FFP:PRBC transfusion improved from 1:3 to 1:2 (p Conclusion Implementation of a MHP results in improved delivery of Blood Components and a reduction in the waste of Blood products compared to the older model of MTP. In combination with educational programmes MHP can significantly improve Blood product administration and patient outcomes in trauma haemorrhage. Level of evidence Level III diagnostic test study.
Nicola Curry - One of the best experts on this subject based on the ideXlab platform.
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Damage control resuscitation using Blood Component Therapy in standard doses has a limited effect on coagulopathy during trauma hemorrhage
Intensive Care Medicine, 2015Co-Authors: S Khan, Ross Davenport, Imran Raza, Simon Glasgow, Henry D. De’ath, Pär I. Johansson, Nicola Curry, Simon J. Stanworth, Christine Gaarder, Karim BrohiAbstract: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.
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Damage control resuscitation using Blood Component Therapy in standard doses has a limited effect on coagulopathy during trauma hemorrhage
Intensive care medicine, 2014Co-Authors: S Khan, Ross Davenport, Imran Raza, Simon Glasgow, Henry D. De’ath, Pär I. Johansson, Nicola Curry, Simon J. Stanworth, Christine Gaarder, Karim BrohiAbstract:Objective To determine the effectiveness of Blood Component Therapy in the correction of trauma-induced coagulopathy during hemorrhage.