Factors in the Initial Resuscitation of Patients With Severe Trauma

作者：Luís Teodoro da Luz, Keyvan Karkouti, Jo Carroll, Deep Grewal, Marti Jones, Jennifer Altmann, Yulia Lin, Akash Gupta, Avery B. Nathens, Amie Kron, Lowyl Notario, Andrew Beckett, Andrew Petrosoniak, Katerina Pavenski, Kelly Vogt, Ziad Solh, Ian Ball, Neil Parry, Paul T. Engels, Michelle P. Zeller, Donald M. Arnold, Emilie P. Belley‐Côté, Chris Evans, Jordan Leitch, Andrew W. Shih, Philip Dawe, R. K. Gooch, Jeannie Callum · 发表于：JAMA Network Open · 年份：2025 · DOI：10.1001/jamanetworkopen.2025.32702 · 被引用次数：6 · 研究领域：Trauma, Hemostasis, Coagulopathy, Resuscitation、Trauma and Emergency Care Studies、Blood transfusion and management

Importance: Patients with bleeding and coagulopathic trauma often require more transfusions and have higher mortality rates, motivating research on improving hemostatic strategies. Objective: To evaluate the replacement of clotting factors with frozen plasma (FP) or factor concentrates (fibrinogen concentrate [FC] and prothrombin complex concentrate [PCC]) in the initial resuscitation of patients with trauma. Design, Setting, and Participants: This multicenter, parallel-control, superiority randomized clinical trial was conducted at 6 level I trauma centers in Canada, between April 2021 and February 2023. Eligible patients were those with massive hemorrhage protocol (MHP) activation on admission and aged 16 years or older. Patients were excluded if they received more than 2 red blood cell (RBC) units either before hospital admission or in the hospital prior to randomization or if they had a catastrophic head injury. Follow-up was completed on March 25, 2023. The primary analysis was based on the modified intention-to-treat approach. Interventions: The intervention group received FC 4 g and PCC 2000 IU in MHP packs 1 and 2. The control group received 4 FP units. Concurrently, patients received 4 RBC units (both packs) and 1 dose of platelets (pack 2). After pack 2, FP was administered at clinician discretion. Main Outcomes and Measures: Primary outcome was the number of allogeneic blood product (RBC, FP, and platelet) units administered within 24 hours. Secondary outcomes incl...