ISICEM 2019

Professor Donat Spahn

Meet the expert

Donat Spahn is a Professor of Anaesthesiology and Chairman of the Institute of Anaesthesiology at University Hospital Zürich, Switzerland.

The elements of trauma induced coagulopathy

Professor Donat Spahn discusses the elements of trauma induced coagulopathy (TIC) from pre-existing conditions and co-morbidities to tissue damage and haemorrhage and the eventual critical reduction of coagulation factors, such as fibrinogen, through various mechanisms.

Coagulopathy is frequent after major trauma and fibrinogen becomes critically reduced first in many trauma patients. Watch to discover the elements of TIC from initial tissue damage to the critical reduction of coagulation factors.

Updates to the European guideline on the management of major bleeding following trauma

Announcing the launch of the 5th Edition of the European guideline on the management of major bleeding following trauma and noting new changes, Professor Donat R. Spahn shares new updates and stresses that compliance with this new guideline improves survival.

Professor Donat Spahn shares the new updates to the European guideline on the management of major bleeding highlighting. Learn how the new guidelines better reflect the decision-making process along the patient pathway and how they are now organised in a temporal sequence from a patient or problem-oriented perspective.

Key recommendations from the European guidelines of trauma management

Professor Donat Spahn summarises the key recommendations from the European guidelines of trauma management covering topics such as viscoelastic coagulation monitoring, antifibrinolytic agents, coagulation resuscitation, goal-directed coagulation algorithms and treatment with fibrinogen.

Learn how routine practice should include early and repeated monitoring of haemostasis. Also learn why tranexamic acid, an antifibrinolytic, should be administered as soon as possible and why fresh frozen plasma (FFP), pathogen-inactivated FFP or fibrinogen concentrate and red blood cells (RBC) should be used for the initial management of patients with massive haemorrhage.

Dr Daniel Dirkmann

Meet the expert

Daniel Dirkmann is Associate of Anaesthesiology and Intensive Care Medicine at Essen University Hospital, Germany.

Is viscoelastic testing better than standard plasmatic coagulation testing?

Coagulopathy increases mortality in trauma patients, yet testing is blind to coagulation. In this video, Dr Daniel Dirkmann describes the two schools of thought – an immediate and simple transfusion package or a more investigative method. He also discusses the issues with current laboratory testing and the benefits of viscoelastic testing.

Despite the link between mortality and coagulopathy, current testing is slow and does not yield enough information on coagulation. Find out why Dr Daniel Dirkmann suggests that an investigative method, with viscoelastic testing, may provide better results.

The advantages of thromboelastometry over standard plasmatic coagulation testing

In this video, Dr Daniel Dirkmann shares data showing that thromboelastometry (ROTEM) is a faster investigatory method than standard plasmatic coagulation testing. He also describes how a ROTEM graph can reveal a wide range of information on the patient and how this can be used to determine the best treatment options.

Coagulation testing needs to be faster and give more detailed information. Find out how viscoelastic testing is faster and yields more results than standard plasmatic coagulation testing. Also learn how thromboelastometry can reveal information on thrombin generation, fibrin concentration and polymerisation, fibrin platelet interaction and fibrinolysis alterations.

The importance of clot firmness, fibrinogen and tranexamic acid in treating trauma induced coagulopathy

Dr Daniel Dirkmann emphasises the significance of clot firmness and fibrinogen, showing that a functional model could use CA5 detection for identifying patients who require massive transfusion and a fibrinogen specific assay for trauma induced coagulopathy. He also explains the remaining uncertainty about hyperfibrinolysis treatment with tranexamic acid.

Find out how a functional model could use a CA5 detection to identify patients who require massive transfusion and a fibrinogen specific assay for the treatment of trauma induced coagulopathy. Also learn about the uncertainty that remains in treating hyperfibrinolysis with tranexamic acid.

How can we transfuse only what the patient needs?

Dr Daniel Dirkmann addresses how platelet function testing could be beneficial in developing treatment algorithms. He also shows how a standard transfusion protocol has increased plasma wastage compared with transfusion guided by laboratory results and how viscoelastic ROTEM testing is a great tool to allow for the transfusion of only what the patient requires.

Find out how platelet function testing could be beneficial to implement in treatment algorithms and how a standard RBC, FFP and platelet transfusion protocol, in a 1:1:1 ratio, has a greater plasma wastage compared to laboratory guided transfusion. Also learn how viscoelastic ROTEM testing is a useful tool for transfusion.

Professor Petra Innerhofer

Meet the expert

Petra Innerhofer is a Professor and Head of Department of Anaesthesiology and Intensive Care Medicine at Innsbruck Medical University, Austria.

Are coagulation factor concentrates more effective than fresh frozen plasma?

A complex sequence of processes is induced if hypoperfusion develops, so what specifically stops bleeding? In this video, Professor Petra Innerhofer describes the question of whether elevating the concentration of all coagulation factors is sufficient to stop bleeding or if fibrinogen concentrate alone would be more effective.

Early effective correction of hypofibrinogenemia is really important. With a complex sequence of processes induced if hypoperfusion develops, Professor Petra Innerhofer questions whether fibrinogen concentrate alone is sufficient to stop major bleeding compared to FFP.

Comparing coagulation factor concentrates against fresh frozen plasma: the RETIC trial

Professor Petra Innerhofer describes the study design of the RETIC (Reversal of TIC using first-line coagulation factor concentrates (CFC) or FFP) single-centre, parallel-group, open-label, randomized trial. The RETIC trial assessed the superiority of CFC, mainly fibrinogen concentrate, to FFP based therapy in adult patients with major trauma.

Find out how the RETIC single-centre, parallel-group, open-label, randomized trial was designed to assess the superiority of CFC to FFP. Also learn why difference between the groups in the rate of multi-organ failure (MOF) was chosen as the primary endpoint.

Effective hypofibrinogenemia correction with fibrinogen concentrate: Results from the RETIC trial

Sharing the results of the RETIC trial, Professor Petra Innerhofer shows how early effective correction of hypofibrinogenemia is really important and can be achieved with fibrinogen concentrate but not FFP.

Professor Petra Innerhofer shows how CFC improves fibrin polymerisation, increases clot firmness and slows platelet reduction while FFP had no beneficial effect. She also describes how treatment efficacy was far greater after CFC administration than after FFP transfusion and how rescue therapy was needed in far more patients with FFP than CFC.

The importance of viscoelastic testing and fibrinogen: Results from the RETIC trial

Professor Petra Innerhofer continues to describe the RETIC trial showing how patients had worse outcomes on FFP than CFC with diffuse and massive bleeding, requiring platelet concentrates and RBC more frequently as well as a higher rate of massive transfusion and MOF. She also reveals how it is actually clotting that stops bleeding rather than a lower international normalised ratio (INR) after FFP.

In this trial, fibrinogen concentrate was seen to improve clot strength, limit coagulopathic bleeding, exhibit a platelet-saving effect, limit transfusion requirements and decrease the risk for MOF. Dr Innerhofer’s take-home message in this video is that clinicians should closely monitor patients with viscoelastic tests, administer the factor needed, which will most frequently be fibrinogen.