Appropriate fibrinogen levels in trauma and other massive bleeding scenarios have been demonstrated to benefit patient outcomes, total blood product use, and several other inpatient metrics. The major hurdle for those involved with the care of patients undergoing hemorrhagic shock is delivering this crucial factor within the first hour(s) of a major bleed. Cryoprecipitated Antihemophilic Factor (Cryo) must be stored in a frozen state until required for transfusion. It can take up to 45 minutes to thaw & deliver while fibrinogen concentrates must be reconstituted and may lack some of the other vital components necessary for response to trauma. Cryo is handled in this manner due to the short shelf life after thawing (4-6 hours, depending on the pooling system) and therefore suffers from the noted time delay to delivery. Several trials have explored the efficacy of early Cryo, or fibrinogen concentrate, in trauma and the feasibility of providing these products in a reasonable timeframe to have an impact. Here we will review the evidence behind early fibrinogen replacement in massive bleeds and the consideration for a novel cryoprecipitate product that has undergone pathogen reduction. This process allows the product to be stored at room temperature in a liquid state and delivered rapidly to ORs and EDs. We will cover the various logistics of implementation, including considerations for the appropriate patient population for use, financial impacts, supply & waste, and also look at the early signs of benefit after implementation from two large academic institutions. These benefits have included reduced turnaround time for delivery and reduction in waste. Clinical outcome analysis is in its early stages since implementation. Still, metrics being monitored, and an ongoing multi-institution study will be discussed.
Understand the impacts of early fibrinogen replacement in massive bleeds
Navigate the implementation of a novel blood product
Understand the benefits of a pathogen reduced cryoprecipitate on blood inventory management
Clinical Assistant Professor of Pathology,
Stanford University School of Medicine