Description

Prehospital Fibrinogen Levels in Major Trauma Patients Transported by Helicopter Emergency Medical Service: Determining Who Might Benefit
Pretty S, O’Dochartaigh D, Cross E, Violato E, Zwicker J, Gauri A, Chen P, Cravetchi X, Widder S, Parker A, Aguilar LS, Douma MJ, Chang E Ahead of Print.
Publication Type: Journal Article

Abstract:
Objectives: Low fibrinogen contributes to poor outcomes in patients with traumatic coagulopathy. Empiric fibrinogen re-placement is not supported. Early identification of patients at high risk of hypofibrinogenemia may enable targeted support. We sought to identify prehospital variables associated with hypofibrinogenemia at emergency department (ED) arrival.

Methods: We retrospectively reviewed health records (January 2015 to August 2019) of consecutive patients transported by helicopter EMS to two trauma centers who received one or more units of packed red blood cells (pRBCs) during trans-port. The primary outcome was first ED fibrinogen level trans-formed into a binomial variable (<1.6g/L or ?1.6g/L) for the 65 patients analyzed. Direct multivariable logistic regression examined the independent variables (hypotension, shock in-dex (SI), and systolic blood pressure. Odds ratios and 95% CIs were reported.

Results: Hypotension after first pRBC transfu-sion was significantly associated with low ED first fibrinogen level, P=.03, with 6.6 (1.1-40.15) times greater odds of fibrin-ogen <1.6g/L. Hypotension post-transfusion was also associ-ated with ED first international normalized ratio (INR)>1.5, P=.013, with those cases having 17.5 (1.8-169.2) greater odds of INR >1.5. Additionally, an EDSI ?1.5 had 8.9 (1.9-42.6) times greater odds of fibrinogen <1.6g/L than those with an EDSI <1, P=.006. Compared with the EDSI 1-1.49 group, those with an EDSI?1.5 had 6.9 times greater odds of having fibrinogen <1.6g/L, P=.02, OR=6.9 (1.3-36.1).

Conclusion: In major trauma patients transported by helicopter EMS, per-sistent hypotension after the first blood transfusion and an ini-tial EDSI ?1.5 were both associated with low fibrinogen levels.

Keywords: Fibrinogen; air ambulances; emergency helicopters; HEMS; trauma; prehospital; hemorrhage; emergency medical services; transfusion

PMID: 41402981

DOI: 10.55460/T0ZU-OA0G