B. Zahoor1, S. Kent1, J. Piercey1, M. Randell1, K. Tetsworth1, D. Wall1 1Royal Brisbane & Women’s Hospital,Trauma,Brisbane, QLD, Australia
Introduction: ROTEM guided transfusion in the management of acutely injured patients has contributed significantly in their care especially when compared to earlier transfusion goals of standard ratio. Of particular interest, patients who sustain pelvic injury and require transfusion constitute a special and fragile population have the potential to benefit from ROTEM guided management. We introduced the use of ROTEM in our trauma service to guide our transfusion protocol and wanted to quantify any differences observed in the management of these critically ill patients.
Methods: We completed a retrospective review, at our Level 1 Trauma center, from 2011-2016. We selected for adult patients who sustained both a pelvic injury and required transfusion. We further classified this cohort according to whether transfusion goals were directed by ROTEM or Standard Ratio. Our primary outcome of interest was the need for pelvic packing, which is the primary surgical intervention of choice at our institution who present with severe pelvic injury and do not improve with conservative management.
Results: Our review yielded 46 patients who sustained both a pelvic injury and required transfusion. Our study population mean demographics were described as follows: mean age of 43 y.o, admission BP 99/63 mmHg, admission HR 124 bpm, admission SI 1.22, admission GCS 8 and admission ISS 31.2. Twenty-nine patients were managed with Standard Ratio (1:1:1) transfusion goals in reference; of these, 17 (59%) underwent pelvic packing in the management of their pelvic injury. Seventeen patients were managed with ROTEM guided transfusion; 7 (41%) of these patients underwent pelvic packing in the management of their pelvic injury. Of note, all patients survived at 30 days post admission.
Conclusion: At our institution, the introduction of ROTEM guided transfusion in patients who sustained pelvic injury was associated with a decrease in need for pelvic packing. This is in comparison to patients who were transfused using
traditional goals of standard ratio. Further study is warranted to look at additional variables in patient management to fully elaborate the benefit of using ROTEM guided transfusion in pelvic injury patients who from our limited experience seem to benefit from a reduced surgical intervention rate and risk.