Trauma Induced Coagulopathy (TIC)
Most of the patients that expire within the first hours of injury bleed to death. In recent years, major changes in resuscitation have been introduced including balanced transfusion strategies.
Reduced coagulation
In patients with severe trauma and blood loss, the ability to form blood clots tends to be reduced shortly after the injury, related to the magnitude of tissue injury and shock. This condition has been named trauma induced coagulopathy (TIC) and is associated with increased morbidity and mortality.
Treatment response
Rapid recognition and optimal treatment of TIC are crucial to improve outcome in these patients. As a partner in the international trauma research network INTRN, TIC has become a major research area in our group.
Jostein Hagemo defended his PhD-thesis “Trauma induced coagulopathy - early detection and experimental modelling with emphasis on the role of fibrinogen” in 2017. He described some of the early changes in coagulation following injury including how deficiency of the protein fibrinogen is related to mortality and aspects of the value of the Viscoelastic Haemostatic Assays (VHAs) TEG and ROTEM in early identification of TIC and prediction of transfusion requirements.
Targeted Action of the Cure of TIC (TACTIC)
The multicenter randomized controlled study iTACTIC was an important part of the EU funded FP7 project TACTIC (Targeted Action of the Cure of TIC) run by INTRN with professor Gaarder as the co-chief investigator for the RCT including about 400 patients enrolled at major European trauma centres.
The iACTIC-RCT
iTACTIC compares VHA guided transfusion strategy versus a treatment guided by conventional coagulation tests in bleeding trauma patients. The algorithms used in iTACTIC were the first to be developed based on a large cohort of trauma patients prospectively observed within the INTRN network. Inclusion was completed in 2018.
The primary endpoint was the proportion of subjects alive and free of massive transfusion (<10 units red blood cells) at 24 hours. Secondary outcomes included the effect of CCT versus VHA-guided therapy on organ failure, total hospital and intensive care lengths of stay, health care resources needed and mortality. Based on some of the results from the RCT were presented in Kjersti Baksaas-Aasen’s PhD (2021).
Trauma response from July 22nd, 2011
Oslo University Hospital was responsible for the initial and definitive treatment of the majority of the severely injured victims from the twin terrorist attacks on July 22, 2011.
The description of the hospital response, specific injury patterns and outcome is the subject of the PhD project of Joakim Jørgensen, which also includes an evaluation of the disaster preparedness in Norwegian hospitals with estimated completion in 2022.
In his PhD project, Iver Anders Gaski is examining the effect of changes in resuscitation strategies with special focus on the massively transfused trauma patients in general and cohorts of patients with severe pelvic fractures, severe liver injuries.
Trauma and age
Although trauma are important contributors to morbidity and mortality in childhood and among the elderly, most of the existing body of evidence concerns previous healthy adults and treatment is guided thereafter.
Less is known about the extremes of age, and in his PhD project “Extremes of age; Causality and consequences of trauma in the pediatric and geriatric population”, Amund R. Hovengen aims at increasing our understanding of consequences from trauma in the geriatric and pediatric populations.
In his PhD project, Peter Wiel Monrad-Hansen will evaluate the effects of the contemporary treatment of pancreatic and duodenal injuries in both the adult and the pediatric population at Oslo University Hospital.
Pain treatment
Pain and treatment of pain in the severely injured patients is another area we have focused on during the last years. Evaluation of current practice is part of our research strategy.