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Multicenter Study
. 2013 Jul;75(1 Suppl 1):S31-9.
doi: 10.1097/TA.0b013e31828fa3ed.

Cryoprecipitate use in the PROMMTT study

John B Holcomb  1 , Erin E Fox, Xuan Zhang, Nathan White, Charles E Wade, Bryan A Cotton, Deborah J del Junco, Eileen M Bulger, Mitchell J Cohen, Martin A Schreiber, John G Myers, Karen J Brasel, Herb A Phelan, Louis H Alarcon, Peter Muskat, Mohammad H Rahbar; PROMMTT Study Group
Collaborators, Affiliations
Multicenter Study

Cryoprecipitate use in the PROMMTT study

John B Holcomb et al. J Trauma Acute Care Surg. 2013 Jul.

Abstract

Background: There are few clinical data to guide the use of cryoprecipitate in severely injured trauma patients. Cryoprecipitate is a rich source of fibrinogen and has been associated with improved survival in animal as well as limited human studies. Our objectives were to identify patterns and predictors of cryoprecipitate use and determine whether transfusing cryoprecipitate was associated with improved survival.

Methods: This secondary analysis of 1,238 of 1,245 PRospective Observational Multicenter Major Trauma Transfusion (PROMMTT) study patients who had timed transfusion data included 359 (29%) who received cryoprecipitate. For this analysis, one dose of cryoprecipitate was defined as 10 U. Unadjusted predictors of cryoprecipitate use were identified using logistic regression. Multivariable time-dependent Cox models were performed to examine the association of cryoprecipitate on time to in-hospital death.

Results: Cryoprecipitate use varied significantly by center, ranging from 7% to 82%. Among patients who received cryoprecipitate, the median number of units infused by 24 hours was 10 (interquartile range, 10-20). The median time from admission to first cryoprecipitate unit was 2.7 hours (interquartile range, 1.7-4.4 hours). Of those who died of a hemorrhagic death within 6 hours of admission, 72% received no cryoprecipitate. Other unadjusted predictors of cryoprecipitate use included Injury Severity Score (ISS), initial fibrinogen levels, base deficit, international normalized ratio, prothrombin time/partial thromboplastin time, hemoglobin, damage-control surgery, and surgical intervention of the chest and abdomen. Cryoprecipitate use was not associated with in-hospital mortality after adjusting for initial pH, initial hemoglobin, emergency department systolic blood pressure, emergency department Glasgow Coma Scale (GCS) score, blood product use, ISS, and center.

Conclusion: Ten US Level 1 trauma centers vary greatly in their timing and use of cryoprecipitate in severely injured trauma patients. We could not identify any association of cryoprecipitate use with in-hospital mortality, although most patients did not receive this product. Randomized controlled studies are needed to determine if cryoprecipitate (or fibrinogen concentrates) have a beneficial effect.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Holcomb reported serving on the board for Tenaxis, the Regional Advisory Council for Trauma, and the National Trauma Institute; providing expert testimony for the Department of Justice; grants funded by the Haemonetics Corporation, and KCI USA, Inc. and consultant fees from the Winkenwerder Company. Dr Wade reported serving on the Science Board for Resuscitation Products, Inc. and the Advisory Board for Astrazeneca. No other disclosures were reported.

Figures

Figure 1
Figure 1
Fibrinogen:RBC ratio over the first 24 hours after admission. 1a. All PROMMTT patients 1b. PROMMTT patients with an admission INR ≥ 1.3
Figure 1
Figure 1
Fibrinogen:RBC ratio over the first 24 hours after admission. 1a. All PROMMTT patients 1b. PROMMTT patients with an admission INR ≥ 1.3
See this image and copyright information in PMC

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