Thread by @CritCareReviews

➡️ There are ~ 5.8 million trauma deaths per year globally
➡️ Trauma is the largest cause of death below the age of 50
➡️ One-third of severely injured trauma patients are coagulopathic at hospital arrival
➡️ Fibrinogen is often used, but is it effective?

a short 🧵

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➡️ Trauma-induced coagulopathy is due to inflammation & shock
➡️ It is worsened by hypothermia, acidosis, and hemodilution
➡️ Coagulopathy due to hemorrhage is strongly associated with mortality
➡️ 1/3 of early trauma deaths are due to uncontrolled haemorrhage

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➡️ Fibrinogen is depleted early during major bleeding
➡️ It can be replaced with fresh frozen plasma, cryoprecipitate or fibrinogen concentrate
➡️ Cryoprecipitate includes fibrinogen, factor VIII coagulant, von Willebrand factor, fibronectin & factor XIII

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➡️ Despite physiological rationale for fibrinogen in traumatic haemorrhage, an evidence gap exists
➡️ Observational data are promising, but subject to confounding
➡️ RCTs of cryoprecipitate are feasibility orientated
➡️ Fibrinogen concentrate studies have been disappointing

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➡️ Despite this, the latest 2023 European trauma haemorrhage guidelines recommends its use for
🔴 initial haemostatic support
🔴 major bleeding accompanied by hypofibrinogenemia

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➡️ Could fibrinogen supplementation divert focus from other more effective therapies?
➡️ Is it a cost effective practice?
➡️ What is its role in the management of the severely injured trauma patient?

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🚩 Enter the CRYOSTAT-2 trial

➡️ Randomised & controlled
➡️ Early cryoprecipitate in severe traumatic haemorrhage
➡️ 3 pools (15 units – 6g fibrinogen) of cryoprecipitate
➡️ 1568 adult trauma patients
➡️ Powered for a 7% 28 day mortality difference (26% to 19%)

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➡️ Join us in @TitanicBelfast to hear @karimbrohi present the results of the @CRYOSTAT_2 trial at #CCR23
➡️ Will we be using cryoprecipitate routinely for all patients with major traumatic haemorrhage?

Register at criticalcarereviews.com/meetings/ccr23

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@TitanicBelfast @karimbrohi @CRYOSTAT_2 ➡️ #CCR23 is supported by

🔴 @VisitBelfast
🔴 @belfastcc
🔴 @NITouristBoard
🔴 @BelfastTrust

See you in Belfast in June!

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@TitanicBelfast @karimbrohi @CRYOSTAT_2 @VisitBelfast @belfastcc @NITouristBoard @BelfastTrust References

cryostat2.co.uk/downloads/2020…
doi.org/10.1186/s13054…
doi.org/10.1038/s41572…
doi.org/10.1186/s13017…

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