Effect of pre-hospital blood products on Acute Traumatic Coagulopathy in a model of severe military trauma

Acute traumatic coagulopathy (ATC) is seen in 30% to 40% of severely injured civilian and military casualties. Early use of blood products attenuates ATC, but the timing for optimal effect is unknown. Emergent clinical practice has started pre-hospital deployment of blood components (combined packed red blood cells [PRBC] and fresh frozen plasma [FFP]),but this is associated with significant logistical burden and some clinical risk. It is therefore imperative to establish whether pre-hospital use of blood products is likely to confer benefit. This study compared the potential impact of pre-hospital resuscitation with blood components versus 0.9% saline in a model of severe injury. Terminally anaesthetised Large White pigs received controlled soft tissue blunt injury, controlled haemorrhage (35% blood volume) with or without a primary blast injury followed by a 30-min shock phase. The animals were allocated randomly to one of the two injury arms (blast or sham blast). Within each injury arm the animals were allocated randomly to one of two treatment groups as follows: the shock phase was followed by a 60-min prehospital evacuation phase; comprising hypotensive resuscitation (target systolic arterial pressure 80 mmHg) using either 0.9% saline or blood components (PRBCs:FFP in a 1:1 ratio). Following this phase, an inhospital phase involving resuscitation to a normotensive target (110 mmHg systolic arterial blood pressure) using PRBCs:FFP was performed in all four groups. A coagulopathy developed in both pre-hospital saline groups (increase in TEG [thromboelastography] R and K times and aPTT [activated partial thromboplastin time]) that persisted for 60 to 90 minutes into the inhospital phase. The coagulopathy was attenuated in the pre-hospital blood component groups. Pre-hospital blood component resuscitation may therefore attenuate ATC