Strategy of Transfusion in Trauma Patients - STATA Trial
Condition: Wounds and Injuries
MeSH terms: Wounds and Injuries
Study type: Interventional
Phase: Phase 4

Summary: 
      The purpose of this study is to compare two already validated methods for massive transfusion
      in trauma patients admitted to the emergency room of a large reference hospital.
    

Detailed description: 
      In this randomized trial trauma patients in need of massive transfusion will be assigned to
      one of the following transfusion strategies:

        1. - Fresh Frozen Plasma, Platelets Concentrate and Packed red blood cells in 1:1:1 ratio.

        2. - These patients will receive Red blood cells based on Haemoglobin measurements and will
           receive either Beriplex® P/N (CSL Behring GmbH, Marburg, Germany) or Haemocomplettan® P
           (CSL Behring, Marburg, Germany), or Platelets based on thromboelastometry.

      To be included patients must meet the following inclusion criteria:

        1. - Trauma victims

        2. - Adults between 18 - 80 years old

        3. - Injury Severity Score (ISS) between 15 and 45

        4. - Assessment of Blood Consumption (ABC) Score ≥ 3 points

        5. - Shock Index ≥ 1,2

        6. - Acute hemorrhage of more than 50% estimated blood volume in 3 hours or more than 1,5
           ml/kg/min of blood during 20 minutes.

      Exclusion Criteria:

        1. - Early cardiac arrest

        2. - Pregnancy

        3. - Injury Severity Score (ISS) > 45

        4. - Patient transferred from another hospital

        5. - Drug abuse history

        6. - Known coagulation impairment

        7. - Known use of anticoagulants, or platelet antiaggregants.

      The group of health-care providers recruiting the patients based on eligibility criteria, is
      different than the group that evaluates the clinical outcomes of the included patients, in
      such a way that no researcher is tasked with post-randomisation care of the subjects. This is
      done to prevent observational bias.

      Two informed consent forms are signed for each patient. The first one is signed by an
      independent physician. Another consent form is signed by the patient's family or the own
      patient within 24 hours of hospital admission.

      The randomisation is performed by sealed envelopes assigned to the eligible patients anytime
      they reach the protocol criteria. The envelopes were created using a computer generated
      randomisation table specifically designed to this study.

      An interim analysis was performed in October 2015 and it showed that there was no increased
      mortality or morbidity within the intervention group.
    

Intervention name(s): Blood Products only; Point of Care guided
Intervention type(s): Other; Other
Intervention description(s): Based solely on massive transfusion triggers Patients with traumatic hemorrhage that fulfil the inclusion criteria will receive blood products by prescription of the patient's anesthesiologist. The patient will be constantly observed and bleeding triggers will be reassessed hourly.; Based on massive transfusion triggers and thromboelastometry Patients with traumatic hemorrhage that fulfil the inclusion criteria will receive the drugs guided by the results of the thromboelastometry. The dosis of each drug will be based on the analysis of the thromboelastometry curves (established algorithm).
Other intervention name(s): Red blood cells; Platelets; Fresh frozen plasma; Red blood cells; Beriplex® P/N (CSL Behring GmbH, Marburg, Germany); Haemocomplettan® P (CSL Behring, Marburg, Germany); Prothrombin Complex Concentrates (PCC); Human Fibrinogen
Intervention MeSH terms: Thrombin
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Thrombelastography; Massive Transfusion; Major Trauma; Blood products; Thromboelastometry