Viscoelastic haemostatic assay augmented protocols for major trauma haemorrhage (ITACTIC): a randomized, controlled trial


K. Baksaas‑Aasen, LS Gall, J Stensballe et al.

Intensive Care Med (2021) 47:49–59

Aim of Study

To investigate the impact of TEG-guided resuscitation protocol on outcomes in traumatic haemorrhage

Design & Location

Randomised controlled trial, multi-centre (international)


Patients with traumatic haemorrhage requiring empirical initiation of major haemorrhage protocol.

Randomised to blood product management guided by either TEG or conventional coagulation studies.

Primary Outcome

Survival free of massive transfusion (≥10 RBCs) @ 24h

Secondary Outcomes

Survival @ 6h, 24h, 28/7, 90/7 Total products Ventilator-free & ICU-free days at 28/7 LoS ICU/hospital % with thromboembotic events, MOF, any adverse event


Logistic regression

Intention to treat analysis


No significant difference in primary outcome between groups

67% vs 64% – OR 1.15 (0.76-1.73)

No significant differences in any secondary outcome


Unexpectedly low rates of coagulopathy – accounting for negative result?

No difference in management/blood product use between groups as a result of different investigations – so perhaps unsuprising no difference in outcomes

Stated Limitations from Study

Population was trauma haemorrhage, cf obstetric/medical

Study in MTCs already used to delivering balanced transfusion – potential for greater impact in non-trauma centres?

Discussion from Journal Club Meeting (? Change of practice)

Usefulness of TEG context-dependent e.g. time to availability of blood products. At Kingston hospital, a key factor is the potential usefulness of TEG as additional evidence to facilitate release/authorisation of blood products by our Haematology colleagues.

Summary by Dr P Vila de Mucha. Journal Club Meeting on 23 January 2023

Image from FOAMCast

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