How we treat bleeding patients - the non surgical perspective from Essen

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Information about How we treat bleeding patients - the non surgical perspective from Essen

Published on June 15, 2019

Author: scanfoam

Source: slideshare.net

1. How we treat bleeding patients The non surgical perspective Essen style

2. Who uses Viscoelastic hemostatic assays?

3. Who uses factor concentrates?

4. @rocu_bene Anesthesiologist Intensivist Emergency physician with: NO CONFLICT OF INTERESTS

5. But we use ROTEM in our hospital since: 1999

6. The German Trauma Network in the Region

7. The German Trauma Network in the Region RUHR POTT

8. The German Trauma Network in the Region Population: 5,1 Millionen people

9. The German Trauma Network in the Region Population: 5,1 Millionen people

10. The German Trauma Network in the Region Population: 5,1 Millionen people

11. The German Trauma Network in the Region Population: 5,1 Millionen people (c) J. Dahmen

12. The German Trauma Network in the Region Population: 5,1 Millionen people Christoph 9 since 1975 Christoph 8 since 1978

13. The German Trauma Network in the Region Population: 5,1 Millionen people Christoph 9 since 1975 Christoph 8 since 1978 BGU Trauma Center Duisburg Bergmannsheil Bochum the oldest Trauma hospital in the world Bergmannsheil Buer

14. Why is it necessary to transfuse as little blood as possible? Social reasons 20 40 60 80 100 1980 1990 2000 2010 2020 2030 2040 2050 2060 Age Life expectancy Germany

15. Why is it necessary to transfuse as little blood as possible? Social reasons 20 40 60 80 100 198020102040 Silver Tsunami

16. Why is it necessary to transfuse as little blood as possible? Social reasons 20 40 60 80 100 198020102040 Silver Tsunami We will run out of blood!

17. Why is it necessary to transfuse as little blood as possible? Medical reasons

18. Why is it necessary to transfuse as little blood as possible? Medical reasons Airplane: per flight Lightning: per year Traffic: per 10K inhabitants & year Medical error: per hospital admission FNHTR febrile nonhemolytic transfusion reaction DHTR delayed hemolytic transfusion reaction AHTR acute hemolytic transfusion reaction Carson JL et al. N Engl J Med 2017; 377:1261-72

19. Why is it necessary to transfuse as little blood as possible? Medical reasons

20. Why is it necessary to transfuse as little blood as possible? Medical reasons

21. Why is it necessary to transfuse as little blood as possible? Medical reasons Patient blood management is an evidence based procedure to reduce the need for blood transfusion

22. The crux of transfusion • 2,3-DPG is low • Decreased deformability of pRBC • pRBC tranfusion did not increase oxygen uptake in critical ill patients • Liberal vs restrictive transfusion triggers show no advantages for those patient who received more blood • PBM is associated reduced transfusion need of red blood cell units, lower complication and mortality rate, and thereby improving clinical outcome Int J Mol Sci. 2017 Sep 11;18(9). pii: E1946. doi: 10.3390/ijms18091946. Transfusion of Red Blood Cells to Patients with Sepsis. Chan YL1, Han ST2, Li CH3, Wu CC4, Chen KF5,6,7,8.

23. The crux of transfusion • 2,3-DPG is low • Decreased deformability of pRBC • pRBC tranfusion did not increase oxygen uptake in critical ill patients • Liberal vs restrictive transfusion triggers show no advantages for those patient who received bmore blood • PBM is associated reduced transfusion need of red blood cell units, lower complication and mortality rate, and thereby improving clinical outcome Int J Mol Sci. 2017 Sep 11;18(9). pii: E1946. doi: 10.3390/ijms18091946. Transfusion of Red Blood Cells to Patients with Sepsis. Chan YL1, Han ST2, Li CH3, Wu CC4, Chen KF5,6,7,8. (C) H. Schöchl

24. The risk of transfusion Typical side effects are: • Hemolytic Transfusion Reactions • Febrile Non-Hemolytic Reactions • Allergic Reactions ranging from urticaria to anaphylaxis • Septic Reactions (warm fluid!) • Transfusion Related Acute Lung Injury (TRALI) Circulatory Overload • Transfusion Associated Graft Versus Host Disease Post-transfusion Purpura

25. The crux of transfusion Plasma transfusion: Sarani, Crit Care Med 2008, 36, 1114-1118

26. The crux of transfusion Plasma transfusion: • Increased risk of ARDS, MOF • Large volume is needed • High risk of TRALI, TACO • Only 5% can donor AB - Plasma Injury: July 2011Volume 42, Issue 7, Pages 697–701Higher rate of Multi organ failure retrospective

27. How to measure good coagulation management?

28. Per year: • 28.000 anesthetic procedures • 2400 intracranial operation • 1500 OP with cardiopulmonary bypass • National Center for Aortic dissection • >120 Liver transplantation • 50 Lung transplantation • Biggest sarcoma Center in GER • Biggest Hospital in the Region • Busiest Trauma Center in the Region

29. Per year: • 28.000 anesthetic procedures • 2400 intracranial operation • 1500 OP with cardiopulmonary bypass • National Center for Aortic dissection • >120 Liver transplantation • 50 Lung transplantation • Biggest sarcoma Center in GER • Biggest Hospital in the Region • Busiest Trauma Center in the Region MASS TRANSFUSION (>10U of RBC) in 2018:

30. The university hospital Essen ROTEM @ the Department of anethesiology 22 bed anesthesiological ICU + ECMO center OP Center 2 OP Center 1 OB/Gyn PACU/Trauma ❤

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