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) METHODOLOGY 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 STATISTICS Logistic regression Intention to treat analysis RESULTS 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 CONCLUSIONS/DISCUSSION 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

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