Perioperative treatment algorithm for bleeding burn patients reduces allogeneic blood product requirements
British Journal of Anesthesia, 06/21/2012
Schaden E et al. – The significant reduction in allogeneic blood product requirements during surgical burn wound excision is a prospective proof of concept that a bleeding management algorithm based on thromboelastometry is efficacious. Hypofibrinogenaemia and hyperfibrinolysis are not significant pathomechanisms of bleeding in this setting and rotational thromboelastometry (ROTEM) helps to avoid unnecessary interventions.Methods
- Thirty consecutive patients undergoing surgical excision of burn wounds were enrolled into this prospective, randomized, controlled, single–centre study.
- In the control group, coagulation management was performed according to the clinicians' discretion.
- For the algorithm group, the authors standardized treatment based on the Austrian recommendation for the management of trauma–induced coagulopathy using point–of–care rotational thromboelastometry (ROTEM).
- The main outcome parameter was the cumulative number of allogeneic blood units transfused on the day of surgery.
- The difference between the groups regarding the cumulative use of allogeneic blood products was highly significant with 3.0 (1.3–5.5) blood products in the algorithm group compared with 9.0 (6.0–12.3) in the control group [median (inter–quartile range); P=0.002].
- No plasma was administered in the algorithm group compared with 5.0 (1.5–7.5) units overall in the control group (P<0.001).
- Fibrinogen concentrate administration was not significantly different between the groups (P=0.89).
- Tranexamic acid was not administered.