• D Frith, J Wall, M Baptista, and K Brohi.
• Blizard Institute, Queen Mary University of London, London, UK.
• Shock. 2015 Oct 1;44 Suppl 2:1-2.

IntroductionHaemostatic resuscitation is postulated to support clotting function by replacing pro-coagulant factors in a physiological ratio. The aim of this study was to determine whether haemostatic resuscitation maintains adequate thrombin generation potential during massive transfusion.Methods440 trauma victims presenting to The Royal London Hospital had blood sampled on arrival, after 4 units of red cells and again after 8 units. Red cells were delivered as a component of haemostatic resuscitation together with plasma and platelets in a 1:1.5 ratio.ResultsOn admission, patients with Acute Traumatic Coagulopathy (ATC) had a significant reduction in all parameters of thrombin generation compared to patients without ATC (Lag Time, LT: 3.5 s vs. 3.67 s, p = 0.03. Peak: 312 nM vs. 385 nM, p < 0.001. Endogenous Thrombin Potential, ETP: 1731 nM vs. 1996 nM, p = 0.005). During 4 units of haemostatic resuscitation patients with ATC experienced a 15% decline in all parameters of thrombin generation. Patients without ATC experienced a 25% decline, such that both groups developed similarly low thrombin generating capacity (LT: 2.9 s vs. 3.0 s, p = 0.61. Peak 275 nM vs. 296 nM, p = 0.44. ETP 1488 nM vs. 1528 nM, p = 0.64). Both groups experienced a further 25% decline in thrombin generation during the next 4 units, potentially caused by haemodilution and consumption (LT: 2.3 s vs. 2.6 s, p = 0.19, Peak 214 nM vs. 270 nM, p0.29. ETP: 1090 nM vs. 1123 nM, p = 0.41). Rotational thromboelastometry failed to discriminate patients with low thrombin generating capacity.ConclusionConventional haemostatic resuscitation fails to support the thrombin generation required for fibrinogen conversion; targeted supra-physiological concentrates may be superior for earlier haemostasis.

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