Viscoelastic assay versus conventional coagulation-directed resuscitation for severely injured trauma patients undergoing massive transfusion.

BACKGROUND

The evaluation of coagulopathy in trauma patients traditionally relies on conventional coagulation tests, which assess isolated components of the coagulation cascade. Viscoelastic assays, in contrast, provide whole-blood analysis. Prior studies have shown conflicting results regarding benefits of viscoelastic assay-guided massive transfusion in trauma. This study investigated the impact of viscoelastic assay resuscitation on mortality in severely injured trauma patients, hypothesizing that viscoelastic assay-guided massive transfusion leads to reduced mortality.

METHODS

A single-center pre-post study (2018-2021) of severely injured (Injury Severity Score >15) adult (>18 years old) trauma patients receiving massive transfusion (>4 U within 4 hours or >10 U within 24 hours of packed red blood cells), before (PRE cohort) versus after (POST cohort) viscoelastic assay implementation. The primary outcome was in-hospital mortality.

RESULTS

Of 186 patients, 95 were in the PRE cohort and 91 were in the POST cohort. All demographic details, vital signs, and injury profile including Injury Severity Score were similar between cohorts (all P > .05). Mortality was similar between POST and PRE cohorts (35.2% vs 41.1%, P = .41). However, the POST cohort received more fresh frozen plasma (6 U vs 4 U, P = .006) and total blood products (13 U vs 10 U, P = .006) within 4 hours of arrival and more platelets within 24 hours (2 U vs 1 U, P = .020).

CONCLUSION

At a single level I trauma center, severely injured trauma patients undergoing viscoelastic assay-guided massive transfusion resuscitation received more fresh frozen plasma and overall blood products. However, viscoelastic assay-guided resuscitation had similar mortality and outcomes compared with resuscitation guided by conventional coagulation tests alone. This further supports a lack of benefit for viscoelastic assay-guided massive transfusion for trauma.

LEVEL OF EVIDENCE: Level IV.