Dr Ellie Kitcatt1, Dr Adam Holyoak2, Dr Alistair Hamilton2, Ms Samantha Lennard3, Ms Roberta Ridolfi1, Dr Akmez Latona2, Dr Russel Funch2, Dr Rowan McCarthy4, Dr Clinton Gibbs1
1Retrieval Services Queensland, 2LifeFlight Medical Services, 3Queensland Health, 4RFDS Queensland Section
Biography:
Dr Ellie Kitcatt is an Emergency Physician and Prehospital and Retrieval Medicine Specialist, and Clinical Director for Retrieval Services Queensland (RSQ), Queensland state’s Aeromedical Retrieval Service, and principle investigator for the ROUGE study.
Abstract:
In Feb 2024 Queensland’s Aeromedical Retrieval Services added FibC to the arsenal of tools carried by retrieval teams caring for patients with major traumatic haemorrhage. Queensland’s Lifeflight and RFDS teams administer FibC alongside packed red cells, TXA and calcium in major traumatic haemorrhage, according to specific criteria; FIBAT score >/= 4, Point of Care INR > 1.2, or transfusion > 2 units red cells.
This year the ROUGE study was launched; a state-wide, prospective, non-randomised study, taking paired blood samples for ROTEM & Clauss Fibrinogen prior to administration of FibC and again immediately prior to hospital arrival. ROUGE will recruit 200 patients over a 3 year period and also evaluate a retrospective comparator cohort to assess the management of major traumatic haemorrhage and outcomes prior to, and then following, the introduction of FibC.
We want to know:
-Are we benefitting our patients by committing time, money and personnel to carrying and administering FibC in the resource-limited PHRM environment?
-Are we improving fibrinogen levels?
-Are we reducing overall transfusion requirements?
-Are we accurately identifying patients with low fibrinogen levels in the absence of ROTEM/formal lab testing?
These important questions have not been sufficiently answered in the aeromedical environment, and our answers will be valuable to aeromedical systems across the world.
This presentation will outline the past Queensland state-wide aeromedical retrieval system approach to blood resuscitation in trauma, the present evidence base and the logistical reasons for introducing FibC to our system, and the implementation and initial results of the ROUGE study which will inform future practice.