Showing papers by "Wolfgang G. Voelckel published in 2015"
TL;DR: Administration of FC alone or in combination with PCC resulted in a significant improvement of fibrin polymerisation as measured by an increase in FIBTEM MCF, which results in earlier clot formation and consequently shorter CT.
Abstract: Purified coagulation factor concentrates, such as fibrinogen concentrate (FC) and prothrombin complex concentrate (PCC) are increasingly used as haemostatic therapy for trauma-induced coagulopathy (TIC). The impact of FC and PCC administration on ROTEM parameters among patients with TIC has not been adequately investigated. In this retrospective observational study, changes to ROTEM parameters, induced by three different therapeutic interventions, were investigated: patients receiving FC only (FC-group); patients treated with FC and PCC (FC + PCC-group) and patients treated with PCC only (PCC-group). The study population comprised 96 patients who were predominately male (69 [71.9 %]), median age was 45.0 (26.3–60.0) years, and the median injury severity score was 34.0 (25.0–44.5). Administration of FC resulted in a significant reduction of the clotting time (CT) in both the EXTEM and FIBTEM assays but had no effect on INTEM CT. Clot amplitude (CA) increased significantly in the FIBTEM assay but remained unchanged in the EXTEM and INTEM assays. The combined administration of FC and PCC increased FIBTEM maximum clot firmness (MCF) and normalized EXTEM CT but did not change either INTEM or FIBTEM CT. Following PCC therapy, EXTEM and FIBTEM CT normalized; CA at 10 min after CT measurements decreased significantly in EXTEM, INTEM and FIBTEM. Administration of FC alone or in combination with PCC resulted in a significant improvement of fibrin polymerisation as measured by an increase in FIBTEM MCF. CT is dependent not only on thrombin generation but also on the availability of substrate (fibrinogen). Accelerated fibrin polymerisation rate results in earlier clot formation and consequently shorter CT. PCC administration normalised EXTEM CT below the upper threshold of 80 s. This study was performed at the AUVA Trauma Centre Salzburg, Salzburg, Austria.
46 citations
TL;DR: In some European trauma centres, treatment algorithms have been developed for the administration of coagulation factor concentrates based on visco‐elastic test results, and these are available for immediate use without the need for blood group matching.
Abstract: Trauma-induced coagulopathy represents a life-threatening complication in severely injured patients. To avoid exsanguination, rapid surgical bleeding control coupled with immediate and aggressive haemostatic treatment is mandatory. In most trauma centres, coagulation therapy is established with transfusion of high volumes of fresh frozen plasma. Due to logistic issues, only busy trauma facilities store pre-thawed plasma ready for immediate transfusion. Thus, substantial time delays have been reported between the first unit of red blood cells transfused and the administration of fresh frozen plasma. An alternative for rapid improvement of haemostatic capacity is purified coagulation factor concentrates. They contain a well-defined concentration of coagulation proteins, carry a low risk for transfusion-related lung injury and virus transmission, and are available for immediate use without the need for blood group matching. In some European trauma centres, treatment algorithms have been developed for the administration of coagulation factor concentrates based on visco-elastic test results.
45 citations
TL;DR: In this case series survival with favourable neurological outcome was observed in avalanche victims with short duration of burial only if bystander CPR was immediately performed and ROSC achieved.
26 citations
TL;DR: When a standard isolation unit was subjected to an explosive cabin decompression of 493 hPa, simulating a 32808 ft flight level accident, leak Tightness of the unit was lost due to rupture of the bag caused by over expansion, when the pressure chamber experiment was repeated with a modified unit, distension was minimized by an additional compensation air bag, thus ensuring leak tightness.
Abstract: Air medical transport of patients suffering of highly infectious diseases is typically performed employing portable isolation chambers. Although the likelihood of decompression flight emergencies is low, sustainability of the devices used is crucial. When a standard isolation unit was subjected to an explosive cabin decompression of 493 hPa, simulating a 32808 ft flight level accident, leak tightness of the unit was lost due to rupture of the bag caused by over expansion. When the pressure chamber experiment was repeated with a modified unit, distension was minimized by an additional compensation air bag, thus ensuring leak tightness.
4 citations
01 Jan 2015
TL;DR: In vitro and in vivo studies revealed that starches and dextrans show the greatest negative impact on hemostasis.
Abstract: Colloids and crystalloids are frequently use to restore intravascular volume. Both solutions interfere with the coagulation process in different ways. Increasing amounts of fluids result in dilutional coagulopathy. Artificial colloids exert additive effects on fibrin polymerisation and platelet function. In vitro and in vivo studies revealed that starches and dextrans show the greatest negative impact on hemostasis.
1 citations