The trauma patient in hemorrhagic shock: how is the C-priority addressed between emergency and ICU admission?

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

Marc Maegele³  Bertil Bouillon²  Philip C Spinella⁴  Matthew Borgmann¹  Thomas Brockamp²  Manuel Mutschler²  Thomas Paffrath²  Sigune Peiniger³ 

[1] San Antonio Military Medical Center, 3851 Roger Brooke Drive, San Antonio, TX, 78234, USA;Department of Trauma and Orthopedic Surgery, University of Witten/Herdecke, Cologne-Merheim Medical Centre (CMMC), Ostmerheimerstr.200, Cologne, D-51109, Germany;Institute for Research in Operative Medicine (IFOM), University of Witten/Herdecke, Cologne-Merheim Medical Center (CMMC), Ostmerheimerstr.200, Cologne, D-51109, Germany;Division of Pediatric Critical Care, Washington University in St Louis, St Louis Children’s Hospital, One Children’s Place Suite 5820, Saint Louis, MO, 63110, USA

关键词: Trauma;    Severely injured;    Adult;    Shock;    Platelets count;    Packed red blood cells;    Fresh frozen plasma;    Coagulopathy;    Physiology;   

Others  :  826282
DOI  :  10.1186/1757-7241-20-78

 received in 2012-05-15, accepted in 2012-11-22,  发布年份 2012

【 摘 要 】

Background

Trauma is the leading cause of death in young people with an injury related mortality rate of 47.6/100,000 in European high income countries. Early deaths often result from rapidly evolving and deteriorating secondary complications e.g. shock, hypoxia or uncontrolled hemorrhage. The present study assessed how well ABC priorities (A: Airway, B: Breathing/Ventilation and C: Circulation with hemorrhage control) with focus on the C-priority including coagulation management are addressed during early trauma care and to what extent these priorities have been controlled for prior to ICU admission among patients arriving to the ER in states of moderate or severe hemorrhagic shock.

Methods

A retrospective analysis of data documented in the TraumaRegister of the ‘Deutsche Gesellschaft für Unfallchirurgie’ (TR-DGU®⁾ was conducted. Relevant clinical and laboratory parameters reflecting status and basic physiology of severely injured patients (ISS ≥ 25) in either moderate or severe shock according to base excess levels (BE -2 to -6 or BE < -6) as surrogate for shock and hemorrhage combined with coagulopathy (Quick’s value <70%) were analyzed upon ER arrival and ICU admission.

Results

A total of 517 datasets was eligible for analysis. Upon ICU admission shock was reversed to BE > -2 in 36.4% and in 26.4% according to the subgroups. Two of three patients with initially moderate shock and three out of four patients with severe shock upon ER arrival were still in shock upon ICU admission. All patients suffered from coagulation dysfunction upon ER arrival (Quick’s value ≤ 70%). Upon ICU admission 3 out of 4 patients in both groups still had a disturbed coagulation function. The number of patients with significant thrombocytopenia had increased 5-6 fold between ER and ICU admission.

Conclusion

The C-priority including coagulation management was not adequately addressed during primary survey and initial resuscitation between ER and ICU admission, in this cohort of severely injured patients.

【 授权许可】

   
2012 Peiniger et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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