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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com

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Scott Weingart. EMCrit RACC Podcast 217 – The Ultimate “Ultimate” BVM. EMCrit Blog. Published on February 5, 2018. Available at [https://emcrit.org/racc/ultimate-bvm/ ]

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domingo, 21 de enero de 2018

CRYOSTAT-2

St.Emlyn's

Fibrin/platelet mesh
"You might be aware that an exciting new trial has started called Cryostat-2. This is exciting as it has the potential to improve patient outcomes, but also because it will involve all the Major Trauma Centres in England and 8 international centres, meaning it is an international, multi-centre, randomised controlled trial.
Why?
Bleeding accounts for 40% of all deaths from trauma, many within hours of injury. A recent NIHR Programme Grant for Applied Research found that approximately 7,780 people nationally suffer major haemorrhage each year, of whom an estimated 2,800 will die, at a total cost of nearly £150m to the NHS. Fibrinogen is the key pro-coagulant factor needed for stable clot formation and the earliest clotting protein to fall during active major bleeding. 25% of all trauma patients have abnormal blood clotting, which causes higher rates of major haemorrhage and four fold increased risk of death. This is . As what we know as Acute Traumatic Coagulopathy (ATC) and the Trauma-Induced Coagulopathy (TIC). To clarify the difference, ATC is the coagulopathy that has been shown to occur as a result of tissue damage and the shock process, whereas TIC is ATC plus the effects of resuscitation efforts and inflammation. We know from research, the primary clotting abnormalities in trauma are increased clot breakdown and low fibrinogen levels. The CRASH-2 trial has shown that early treatment with tranexamic acid prevents clot breakdown and reduces mortality from trauma haemorrhage. The results of a national observational trauma transfusion study found cryoprecipitate is administered late during the MHP, on average three hours after arrival. Cryostat-1 showed that early replacement of fibrinogen with cryoprecipitate is able to rapidly restore fibrinogen levels and may halve mortality from trauma haemorrhage. Following on from this work, CRYOSTAT-2 will evaluate whether early administration of high-dose cryoprecipitate, in addition to standard major haemorrhage therapy, improves survival from traumatic bleeding..."