2. Department of Clinical Pathology, Transfusion Medicine Service, Bufalini Hospital, Cesena, Italy.
3. Department of Immunoemathology and Transfusion Medicine, S. Camillo-Forlanini Hospital, Roma, Italy.
4. Department of Intensive Care, Catholic University, Roma, Italy.
5. Department of Anesthesia and Intensive Care, Hospital and University, Udine, Regional Health Agency Emilia-Romagna, Italy.
6. Department of Anesthesia and Intensive Care, Bufalini Hospital, Cesena, Italy.
7. Emergency Department, General Surgery and Trauma Team Niguarda Hospital, Milan, Italy.
8. Department of Anesthesia and Intensive Care, Rummo Hospital, Benevento, Italy.
9. Emergency Department, Intensive Care Unit and EMS, Maggiore Hospital, Bologna, Italy.
10. Dept of Anesthesia and Intensive Care, Maggiore Hospital, Parma, Italy.
In recent years, a strong focus has been put on the need to assure early coagulation support in order to prevent and treat coagulopathy in patients with severe trauma, and to improve survival. Aggressive plasma administration with high plasma/red blood cells ratio is increasingly used worldwide. However, plasma transfusion is associated with increased risks of multiple organ dysfunction syndrome (MODS), adult respiratory distress syndrome (ARDS) and infection, which may prolong hospital stay and the need for artificial ventilation. Moreover, in the majority of European hospitals plasma cannot be immediately available and therefore it has been reported a significant delay in coagulation support. This has lead to the proposal of using clotting factors as an alternative to plasma. However, strong evidence to define the best strategy is still missing, and the only published protocols are Institution-specific, thus depending on the local organization and the available resources. The Italian Trauma Centers Network (TUN) recently developed a treatment protocol aiming at shortening the interval before the onset of coagulation support and at reducing the use of plasma. We present this protocol-Early Coagulation Support (ECS) Protocol-and discuss its rationale. Its implications for the trauma-team workflow and hospital organization are also addressed. The ECS protocol must be considered as an integrated part of a comprehensive Damage Control Strategy. The impact of the ECS Protocol on blood products consumption, trauma mortality and morbidity as well as its financial aspects, will be strictly monitored by the TUN hospitals.
Keywords: Trauma, coagulopathy, transfusion, plasma, clotting factors, protocol, multicenter