Goal-directed Hemostatic Resuscitation of XXXX -induced Coagulopathy: A Pragmatic Randomized Clinical Trial Comparing a Viscoelastic Assay to Conventional Coagulation Assays.

@entity1 @entity548 @entity3459 @entity15928 @entity204 @entity130
BACKGROUND: Massive transfusion protocols (MTPs) have become standard of care in the management of @entity548 injured @entity1 , yet strategies to guide them vary widely. We conducted a pragmatic, randomized clinical trial (RCT) to test the hypothesis that an @entity15928 goal directed by the viscoelastic assay thrombelastography (TEG) improves survival compared with an @entity15928 guided by @entity3459 ( @entity3459 ). METHODS: This RCT enrolled injured @entity1 from an academic level-1 @entity130 center meeting criteria for @entity15928 activation. Upon @entity15928 activation, @entity1 were randomized to be managed either by an @entity15928 goal directed by TEG or by @entity3459 (ie, international normalized ratio, fibrinogen, platelet count). Primary outcome was 28-day survival. RESULTS: One hundred eleven @entity1 were included in an intent-to-treat analysis (TEG = 56, @entity3459 = 55). Survival in the TEG group was significantly higher than the @entity3459 group (log-rank P = 0.032, Wilcoxon P = 0.027); 20 @entity204 in the @entity3459 group (36.4%) compared with 11 in the TEG group (19.6%) (P = 0.049). Most @entity204 occurred within the first 6 hours from arrival (21.8% @entity3459 group vs 7.1% TEG group) (P = 0.032). @entity3459 @entity1 required similar number of red blood cell units as the TEG @entity1 [ @entity3459 : 5.0 (2-11), TEG: 4.5 (2-8)] (P = 0.317), but more plasma units [ @entity3459 : 2.0 (0-4), TEG: 0.0 (0-3)] (P = 0.022), and more platelets units [ @entity3459 : 0.0 (0-1), TEG: 0.0 (0-0)] (P = 0.041) in the first 2 hours of resuscitation. CONCLUSIONS: Utilization of a goal-directed, TEG-guided @entity15928 to resuscitate severely injured @entity1 improves survival compared with an @entity15928 guided by @entity3459 and utilizes less plasma and platelet transfusions during the early phase of resuscitation.
