Highlights from AAST - use of fibrinogen may improve survival

This study of the German trauma registry shows an early benefit when fibrinogen is given to Exsanguinating patients.

ADMINISTRATION OF FIBRINOGEN IN EXSANGUINATING TRAUMA PATIENTS IS ASSOCIATED WITH IMPROVED SURVIVAL AT 6 HOURS BUT NOT AT DISCHARGE Arasch Wafaisade, Rolf Lefering, Thomas Brockamp, Marc Maegele, Manuel Mutschler, Lendemans Sven, Bertil Bouillon*, Christian Probst, University of Witten/Herdecke Sponsor: Raul Coimbra*, M.D., Ph.D. Invited Discussant: John Holcomb Introduction: Despite poor evidence and high costs, fibrinogen concentrate (FC) represents one of the most frequently used hemostatic agents in exsanguinating trauma. The aim was to assess whether the administration of FC in severely injured patients was associated with improved outcomes. Methods: Patients documented in the Trauma Registry of the German Society for Trauma Surgery (primary admissions; Injury Severity Score, ISS≥16) that had received FC during initial care between ER arrival and ICU admission (FC+) were matched with patients that had not received FC (FC─). Results: The matched-pairs analysis yielded two comparable groups with n=294 patients each with a mean ISS of 38±14 (FC+) and 37±13 (FC─) (p=0.73), the mean age was 40±17 vs. 40±16 (p=0.72), respectively. Patients were predominantly male (71.1% in both groups, p=1.0). Upon ER arrival, hypotension (systolic blood pressure ≤90mmHg) occurred in 51.4%(FC+) and 48.0%(FC─) (p=0.41). Patients were administered 12.8±14.3 (FC+) vs. 11.3±10.0 (FC─) red blood cell units (p=0.20). Thromboembolism occurred in 6.8% (FC+) vs. 3.4% (FC─) (p=0.06) and multiple organ failure (MOF) in 61.2% vs. 49.0% (p=0.003), respectively. While 6-hour mortality was 10.5% (FC+) vs. 16.7% (FC─) (p=0.03) and mean time to death was 7.5±14.6 days vs. 4.7±8.6 days (p=0.006), overall hospital-mortality was 28.6% vs. 25.5% (p=0.40), respectively. Conclusion: This is the first trial to study the effect of FC administration alone in bleeding trauma. In our large population of severely injured patients, the early use of FC was associated with a significantly lower 6-hour mortality and increased time to death, but also increased MOF. A reduction of overall hospital mortality was not observed in FC+ patients. These outcome data may implicate that FC converted early deaths from hemorrhage to late deaths from MOF.