Research Paper Title

Viscoelastic Testing in Combat Resuscitation: Is It Time for a New Standard?

Background

Traumatic haemorrhage and coagulopathy represent major sources of morbidity and mortality on the modern battlefield. Viscoelastic testing (VET) offers a potentially more personalised approach to resuscitation. The researchers sought to evaluate outcomes of combat trauma patients who received VET-guided resuscitation compared with standard balanced blood product resuscitation.

Methods

Retrospective analysis of the Department of Defence Trauma Registry, 2008 to 2016 was performed. Multivariate logistic regression analyses of all adult patients initially presenting to NATO Role III facilities who required blood products were performed to identify factors associated with VET-guided resuscitation and mortality. A propensity score matched comparison of outcomes in patient cohorts treated at VET versus non-VET Role III facilities was performed.

Results

There are 3,320 patients, predominately male (98%), median age ranges from 25 years to 29 years, Injury Severity Score of 18.8, with a penetrating injury (84%) were studied. Overall mortality was 9.7%. Five hundred ninety-four patients had VET during their initial resuscitation. After adjusting for confounders, VET during initial resuscitation was independently associated with decreased mortality (odds ratio, 0.63; p = 0.04). Propensity analysis confirmed this survival advantage with a 57% reduction in overall mortality (7.3% vs. 13.1%; p = 0.001) for all patients requiring blood products.

Conclusions

Viscoelastic testing offers the possibility of a product-specific resuscitation for critically injured patients requiring transfusion in combat settings. Routine VET may be superior to non-VET-guided resuscitation for combat trauma victims.

Reference

Lammers, D.T., Marenco, C.W., Morte, K.R., Bingham, J.R., Martin, M.J. & Eckert, M.J. (2020) Viscoelastic Testing in Combat Resuscitation: Is It Time for a New Standard? The Journal of Trauma and Acute Care Surgery. 89(1), pp.145-152. doi: 10.1097/TA.0000000000002634.