Fibrinogen Concentrate - its about bleeding time...
Andrew Hooper / Simon Clarkson
RFDS Western Operations, Jandakot, Australia
Dr. Andrew Hooper (MBBS, BA(Hons), FACEM) Deputy Director Medical Services, Royal Flying Doctor Service, Western Operations.
An Emergency Physician who discovered the joy of providing emergency critical care outside of the ED, and doesn't particularly want to go back inside again.
Acute Traumatic Coagulopathy(ATC) in major haemorrhage is a well recognised phenomenon, associated with increased mortality, transfusion requirements, and prolonged hospital and ICU admission. Central to this coagulopathy are the processes of hyperfibrinolysis, hyperfibrinogenolysis and consequent fibrinogen deficiency.
Identification and management of ATC in the austere retrieval environment may be challenging, where ROTEM testing and laboratory measurements of fibrinogen levels are not available, and severely injured patients need to be transported for many hours, over thousands of kilometres, to major trauma centres.
And what about treating this group of critically injured patients? Acquired hypofibrinogenaemia has been managed in Australia using cryoprecipitate, but this is infrequently available to retrieval services due to limited supplies outside of metropolitan areas, and an inability to store and prepare cryoprecipiate outside of a dedicated transfusion service.
An alternative and increasingly recognised product is fibrinogen concentrate, which is easily stored and administered to patients with critical bleeding. Administration of fibrinogen concentrate as part of a balanced approach to haemostatic resuscitation has been shown to improve haemostasis and reduce blood product use in post partum haemorrhage and cardiothoracic surgery. Treatment of fibrinogen deficiency in major trauma is recommended by many authorities and is well established in several European countries.
Can we, as retrieval clinicians, identify those patients who will benefit from fibrinogen replacement, and treat them during transport, rather than waiting many hours until their arrival into a major trauma centre? At RFDS Western Operations, we believe that we can, and this presentation is how we are going to do it, and how you can too.
Retrieval clinicians currently provide a number of critical interventions that in the past were considered to be the domain of hospital clinicians. Fibrinogen concentrate can be another treatment that we take out of the hospital and into the future of aeromedical practice.