TRAUMA INDUCED COAGULOPATHY & MASSIVE TRANSFUSION KARIM BROHI, - - PowerPoint PPT Presentation

▶
trauma induced coagulopathy amp massive transfusion
SMART_READER_LITE
LIVE PREVIEW

TRAUMA INDUCED COAGULOPATHY & MASSIVE TRANSFUSION KARIM BROHI, - - PowerPoint PPT Presentation

Sep 12, 2023 174 likes •758 views

TRAUMA INDUCED COAGULOPATHY & MASSIVE TRANSFUSION KARIM BROHI, FRCS FRCA Professor of Trauma Sciences Centre for Trauma Sciences Queen Mary University of London www.c4ts.qmul.ac.uk 1 2 3 60% Mortality (%) 40% 20% 0% 0 3 4 7 8

slide-1
SLIDE 1

1

TRAUMA INDUCED COAGULOPATHY & MASSIVE TRANSFUSION

KARIM BROHI, FRCS FRCA

Professor of Trauma Sciences Centre for Trauma Sciences Queen Mary University of London www.c4ts.qmul.ac.uk

slide-2
SLIDE 2

2

slide-3
SLIDE 3

3

slide-4
SLIDE 4

4

0% 20% 40% 60%

0 ‐ 3 4 ‐ 7 8 ‐ 11 12 ‐ 15 16 ‐ 19 20 ‐ 23 24 ‐ 27 28 ‐ 31

Mortality (%) PRBCs in 24 Hours

slide-5
SLIDE 5

5

slide-6
SLIDE 6

6

slide-7
SLIDE 7

7

slide-8
SLIDE 8

8

43%

slide-9
SLIDE 9

9

slide-10
SLIDE 10

10

slide-11
SLIDE 11

11

slide-12
SLIDE 12

12

Acute Traumatic Coagulopathy

ATC

slide-13
SLIDE 13

13

slide-14
SLIDE 14

14

slide-15
SLIDE 15

15

slide-16
SLIDE 16

16

slide-17
SLIDE 17

17

slide-18
SLIDE 18

18

slide-19
SLIDE 19

19

slide-20
SLIDE 20

20

slide-21
SLIDE 21

21

slide-22
SLIDE 22

22

Arrival Post 4 U Post 8 U Post 12 U Post 18 U EXTEM FIBTEM 750 crystalloid 4 PRBC 2 FFP 4500 crystalloid 500 colloid 8 PRBC 7 FFP 1 PLT 2 CRYO 7500 crystalloid 1000 colloid 12 PRBC 8 FFP 18 PRBC 11 FFP

slide-23
SLIDE 23

23

HAEMOSTATIC Resuscitation

  • 1. Early haemorrhage control (DCS)
  • 2. Permissive hypotension
  • 3. Limit fluid infusions (dilution)
  • 4. Target coagulopathy
slide-24
SLIDE 24

24

Hallmarks of ATC

slide-25
SLIDE 25

25

  • 100
  • 80
  • 60
  • 40
  • 20

20 40 60 80 100 10 20 30 40 50 60

Firmness [mm] Time [min]

exTEM PTr Comparison

EXTEM PTR<1.2 EXTEM PTR>1.2

slide-26
SLIDE 26

26

ATC: CA5 < 36mm

slide-27
SLIDE 27

27

slide-28
SLIDE 28

28

slide-29
SLIDE 29

29

slide-30
SLIDE 30

30

slide-31
SLIDE 31

31

slide-32
SLIDE 32

32

slide-33
SLIDE 33

33

slide-34
SLIDE 34

34

slide-35
SLIDE 35

35

slide-36
SLIDE 36

36

Occult Fibrinolysis Normal %ML + PAP 1500‐7000ng/ml Severe Occult Fibrinolysis Normal %ML + PAP >7000ng/ml Overt Fibrinolysis %ML >15%

slide-37
SLIDE 37

37

0% 20% 40% 60%

Normal Occult Severe Occult Overt

% of Patients Hyperfibrinolysis

slide-38
SLIDE 38

38

slide-39
SLIDE 39

39

Mechanism of ATC

slide-40
SLIDE 40

40

Systemic Activation of Protein C

slide-41
SLIDE 41

41

Activated Protein C (ng/ml)

slide-42
SLIDE 42

42

slide-43
SLIDE 43

43

slide-44
SLIDE 44

44

VIIa IXa Xa + + + + XIIa XIa TM TM TM TM Thrombin Fibrin +

platelet

Thrombin-TM

slide-45
SLIDE 45

45

VIIa IXa Xa + XIIa XIa aPC PC

  • Thrombin-TM
  • Thrombin

Fibrin +

platelet

TM TM TM TM

slide-46
SLIDE 46

46

slide-47
SLIDE 47

47

slide-48
SLIDE 48

48

hyperfibrinolysis

slide-49
SLIDE 49

49

VIIa IXa Xa + XIIa XIa aPC PC

  • Thrombin-TM
  • Thrombin

Fibrin +

platelet

TM TM TM TM

slide-50
SLIDE 50

50

VIIa IXa Xa + XIIa XIa aPC PC

  • Thrombin-TM
  • FDPs

Plasmin tPA + Thrombin Fibrin +

platelet

+

slide-51
SLIDE 51

51

VIIa IXa Xa + XIIa XIa aPC PC

  • Thrombin-TM
  • FDPs

Plasmin tPA PAI-1 +

  • Thrombin

Fibrin +

platelet

+

slide-52
SLIDE 52

52

slide-53
SLIDE 53

53

slide-54
SLIDE 54

54

slide-55
SLIDE 55

55

ACUTE TRAUMATIC COAGULOPATHY

Fibrinolysis Fibrinogen loss

slide-56
SLIDE 56

56

slide-57
SLIDE 57

57