Fibrinogen concentrate

Question 1

CRYOSTAT 2

Rationale
*Deaths often occur early – > 50% of patients who die, do so in the first 4 hours
*The most common mechanism of death is haemorrhage, which is exacerbated by coagulopathy and fibrinolysis
*Fibrinogen acts to stabilise clot formation. Trauma causes activation of coagulation pathways and fibrinogen levels drop rapidly due to consumption, fibrinolysis and dilution
*There is an association between low fibrinogen levels and poor outcomes, and it is hypothesised that cryoprecipitate transfusion may ameliorate this state

FIESTY
ANZ trial

Answer 1

In patients with trauma and critical bleeding who require activation of a major haemorrhage protocol-
Does empiric administration of 3 pools of cryoprecipitate (6g fibrinogen) within 90 minutes of randomisation (and no more than 3 hours after injury) improve survival, compared to standard care?

Result:
Early empiric high dose cryoprecipitate in patients with haemorrhage following trauma did not reduce 28-day mortality

FIESTY
In adult trauma patients with major haemorrhage and hypofibrinogenaemia does the use fibrinogen concentrate (FC) compared to cryoprecipitate (cryo) result in a shorter time to administration?

Fibrinogen concentrate
If ROTEM FIBTEM A5 < 10mm then FC administered
Dosage adjusted based on A5 value (ranging from 6g if A5 0mm to 2g if A5 9-10mm)

Results
Median times for commencement of FC vs. cryo following hospital admission – significantly reduced in FC group
29 (23-40) minutes vs. 60 (40 – 80 minutes)

In severely injured, hypofibrinogenaemic patients the administration of FC may be achieved faster than transfusion of cryoprecipitate