gms | German Medical Science

132. Kongress der Deutschen Gesellschaft für Chirurgie

Deutsche Gesellschaft für Chirurgie

28.04. - 01.05.2015, München

Variations in infrastructure, logistics and clinical practice for the detection and management of trauma associated hemorrhage and coagulopathy in Germany

Meeting Abstract

  • Ewa Klara Stürmer - Universität Witten/Herdecke, Institut für Forschung in der Operativen Medizin, Köln, Deutschland
  • Verena Albrecht - Universität Witten/Herdecke, Institut für Forschung in der Operativen Medizin, Köln, Deutschland
  • Nadine Schäfer - Universität Witten/Herdecke, Institut für Forschung in der Operativen Medizin, Köln, Deutschland
  • Arne Driessen - Universität Witten/Herdecke, Lehrstuhl für Orthopädie und Unfallchirurgie, Köln, Deutschland
  • Moritz Schenk - Universität Witten/Herdecke, Institut für Forschung in der Operativen Medizin, Köln, Deutschland
  • Marc Maegele - Universität Witten/Herdecke, Lehrstuhl für Orthopädie und Unfallchirurgie, Köln, Deutschland

Deutsche Gesellschaft für Chirurgie. 132. Kongress der Deutschen Gesellschaft für Chirurgie. München, 28.04.-01.05.2015. Düsseldorf: German Medical Science GMS Publishing House; 2015. Doc15dgch583

doi: 10.3205/15dgch583, urn:nbn:de:0183-15dgch5830

Published: April 24, 2015

© 2015 Stürmer et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Introduction: Massive bleeding is stated to be the most common cause of preventable death in trauma care. Early detection and management of trauma hemorrhage and coagulopathy have been associated with improved outcomes. Today a consistent procedure or national guideline across Germany is lacking.

Material and methods: Therefore, a web based survey consisting of 20 questions addressing treatment algorithms was developed and disseminated via email among surgeons and anesthetists in Germany who are involved in the primary care of bleeding trauma patients.

Results: A total of 106 completed questionnaires were returned. More than 60% of the respondents working in hospitals of all levels of care followed a treatment algorithm, e.g. a massive transfusion protocol. More than 90% of all used the synopsis of haemoglobin, haematocrit, INR/PT, aPTT, platelet counts, lactate, pH, and Base excess to assess haemostatic disorders. 56.6% of the respondents additionally use extended coagulation assays (TEG/ROTEM). Packed red blood cell concentrates (pRBCs), fresh frozen plasma concentrates, prothrombin complex concentrates (e.g. PPSB), tranexamic acid, calcium and vitamin K were available and used by more than 90% of the respondents for the initial treatment of a bleeding trauma patient. All of the respondents declared the time frame between the arrival of the bleeding patients and the administration of the first blood product was less than one hour. (49% <15 min., 48.1% <30 min.). 57.6% claimed there is a need for interdisciplinary training programs to improve clinical skills in the treatment of trauma hemorrhage. In addition more than 65% requested tests for the quicker detection of patients on new oral anticoagulants (NOACs).

Conclusion: Differences in infrastructure and clinical practice for the detection and treatment of trauma hemorrhage and coagulopathy across trauma centers in Germany were confirmed by this survey. The next step will be a closer look on the correlation of different strategies and patients’ outcomes to evaluate their efficacy.