Fibrinogen Concentrate in Trauma
Royal Flying Doctor Service Western Operations, Palmyra, Australia
Andrew Hooper is an Emergency Physician by trade, who now works full time as Deputy Director of Medical Services for Royal Flying Doctor Service Western Operations.
Correction of acute traumatic coagulopathy is a cornerstone of traumatic haemorrhage management.
At the 2017 ASA & FNA conference, Royal Flying Doctor Service Western Operations presented an ePoster, detailing a 5 year retrospective review of trauma patients requiring blood transfusion during aeromedical transfer. We identified a group of patients with likely acute traumatic coagulopathy, who we believe would have benefitted from early fibrinogen replacement, several hours before their arrival at a major trauma centre.
Fibrinogen concentrate is well established in Europe for management of acquired fibrinogen deficiency in traumatic haemorrhage, and has the advantage over cryoprecipitate, of being relatively easy to store and administer in the retrieval environment.
Royal Flying Doctor Service Western Operations is integrating the use of fibrinogen concentrate into the management of major haemorrhage, with an associated audit of its use. This is a first for a retrieval service in Australia, and can advance the pre-hospital management of trauma patients.
This presentation reviews the evidence for fibrinogen concentrate use in trauma, the challenges in identifying patients with acute traumatic coagulopathy in the pre-hospital setting, and the initial results from its use.