Massive bleeding and trauma-induced coagulopathy

We investigate the mechanisms and physiology related to massive bleeding and massive transfusion.

Traumatic injuries explain the majority of bleeding death. The bleeding is aggravated by trauma-induced coagulopathy. The coagulopathy is multifactorial and complex, caused by consumption of coagulation factors, dilution, acidosis etc but also by a more rapid effect induced by the trauma itself.

The exact mechanisms behind this Acute Traumatic Coagulopathy is not fully understood.

The aim of our research is to further investigate the mechanisms and physiology related to massive bleeding and massive transfusion. The results could optimize transfusion guidelines in clinical use and hopefully decrease the high mortality related to massive bleeding.

Project

The aim of our research project is to study massively transfused patients in the Karolinska Hospital and to evaluate the coagulation problems related to massive bleeding and transfusion of blood-products. The involved mechanisms and the optimal use of blood-products are not fully understood and needs further investigations.

In addition to coagulation parameters the project includes studies of long-term effects of blood-products and outcome parameters such as mortality, ICU-days, physiological parameters for ventilation, circulation etc.

The project is planned and conducted in collaboration with the Department of Laboratory Medicine, Division of Clinical Immunology and Transfusion Medicine; the Department of Medical Epidemiology and Biostatistics; and the Coagulation Unit at the Department of Medicine.

Group members

Anders Östlund MD, PhD, Chief of the Section for Trauma and Acute Anesthesiology at Karolinska University Hospital
Agneta Wikman MD, PhD, Department of Laboratory Medicine, Karolinska Institutet
Gustaf Edgren MD, PhD, Department of Medical Epidemiology and Biostatistics, Karolinska Institutet
Anna Ågren MD, PhD, Department of Medicine, Division of Haematology, Coagulation Unit, Karolinska University Hospital
Märit Halmin MD, Department of Epidemiology and Biostatistics, Karolinska Institutet and Department of Anesthesiology and Intensive care, Danderyd Hospital

Financial support

Grant from the Swedish Society for Medical Research (Svenska Sällskapet för Medicinsk Forskning) to Dr Gustaf Edgren.

Publications

Effect of plasma-to-RBC ratios in trauma patients: a cohort study with time-dependent data*.
Halmin M, Boström F, Brattström O, Lundahl J, Wikman A, Östlund A, et al
Crit. Care Med. 2013 Aug;41(8):1905-14

Thromboelastography (TEG®) compared to conventional coagulation tests in surgical patients--a laboratory evaluation.
Ågren A, Wikman A, Holmström M, Östlund A, Edgren G
Scand. J. Clin. Lab. Invest. 2013 Apr;73(3):214-20

Scandinavian Guidelines--"The massively bleeding patient".
Gaarder C, Naess P, Frischknecht Christensen E, Hakala P, Handolin L, Heier H, et al
Scand J Surg 2008 ;97(1):15-36 

Contact us

Anders Östlund, MD, PhD, Chief of the Section for Trauma and Acute Anesthesiology at Karolinska University Hospital

E-mail: anders.ostlund@karolinska.se

Address: Department of Anesthesiology and Intensive Care, Karolinska University Hospital Solna, SE-171 76 Stockholm, Sweden