Clinical Report: Impact of VHA-guided Hemostatic Resuscitation on Survival

Overview

This study evaluates the association between VHA-guided hemostatic resuscitation and clinical outcomes in traumatic hemorrhage patients who survived beyond 24 hours.

Background

Traumatic hemorrhage is a leading cause of preventable mortality in trauma cases, necessitating effective hemostatic resuscitation strategies. The implementation of viscoelastic hemostatic assays (VHA) may enhance coagulation management and improve outcomes in this patient population. Understanding the impact of VHA-guided resuscitation is critical for optimizing trauma care.

Data Highlights

Key Findings

• Post-24-h in-hospital mortality was lower in the VHA-guided group (9 deaths) compared to the CCA-guided group (21 deaths).
• Kaplan–Meier analysis indicated improved survival in the VHA-guided group (log-rank P = 0.015).
• VHA-guided resuscitation was associated with a lower hazard of post-24-h in-hospital death (adjusted HR 0.37, 95% CI 0.16–0.84, P = 0.018).
• The VHA-guided group showed reduced plasma utilization and greater fibrinogen-directed replacement compared to the CCA-guided group.

Clinical Implications

The findings suggest that VHA-guided hemostatic resuscitation may improve survival rates in patients with traumatic hemorrhage. Clinicians should consider the potential benefits of implementing VHA in trauma protocols to enhance patient outcomes.

Conclusion

VHA-guided hemostatic resuscitation is associated with improved post-24-h survival and reduced plasma exposure in traumatic hemorrhage patients.

Related Resources & Content

1. Intensive Care Medicine, 2020 -- Enhanced Protocols for Viscoelastic Haemostatic Assays in Major Trauma Hemorrhage: Results from a Randomized Controlled Trial (ITACTIC)
2. Critical Care, 2021 -- Impact of Early Administration of Tranexamic Acid on Outcomes in Patients with Severe Trauma: A Prospective Cohort Analysis
3. The European guideline on management of major bleeding and coagulopathy following trauma: sixth edition
4. Decline in Blood Transfusions and Mortality from Hemorrhage in Major Pelvic Ring Injuries Over the Past Ten Years
5. Critical Care (Springer) — Hormonal response following hemorrhage after severe trauma: an observational prospective study
6. Thromboelastography and rotational thromboelastometry in bleeding patients with coagulopathy: Practice management guideline from the Eastern Association for the Surgery of Trauma
7. What are the benefits and risks of using thromboelastography (TEG) and thromboelastometry (ROTEM) analysers to guide blood product transfusions in people with severe bleeding?
8. The European guideline on management of major bleeding and coagulopathy following trauma: sixth edition
9. 1 Recommendations | Detecting, managing and monitoring haemostasis: viscoelastometric point‑of‑care testing (ROTEM, TEG and Sonoclot systems) | Guidance | NICE
10. Viscoelastic haemostatic assay augmented protocols for major trauma haemorrhage (ITACTIC): a randomized, controlled trial - PMC
11. Goal-directed Hemostatic Resuscitation of Trauma-induced Coagulopathy: A Pragmatic Randomized Clinical Trial Comparing a Viscoelastic Assay to Conventional Coagulation Assays - PMC
12. Precision hemostasis: how viscoelastic testing guides real-time decision-making in trauma
13. Viscoelastic Hemostatic Assays are Associated With Mortality and Blood Transfusion in a Multicenter Cohort - ScienceDirect