ITACTIC

Viscoelastic haemostatic assay augmented protocols for major trauma haemorrhage (ITACTIC): a randomized, controlled trial
K Baksaas-Aasen et al. @karimbrohi Intensive Care Med 2020. https://doi:10.1007/s00134-020-06266-1

Clinical Question

• In adult trauma patients presenting with signs of haemorrhagic shock does the utilisation of a viscoelastic haemostatic assay (VHA) augmented transfusion strategy compared to a strategy augmented by conventional coagulation tests (CCT) result in an increased number of patients alive and free of massive transfusion at 24 hours?

N = 411, 7 trauma centres in Europe

Authors’ Conclusions

• VHA augmented MHP testing did not improve overall outcomes when compared to CCT augmented MHP

The Bottom Line

• In adult trauma patients presenting with signs of haemorrhagic shock, this trial did not show benefit of viscoelastic haemostatic assay augmented protocols when compared to conventional coagulation tests augmented protocols
• This is a well done, pragmatic trial set out to try and address an area with limited randomised research however given my reservations above, and some of the trends shown, further studies would be warranted before concluding that VHA has no place in the management of bleeding trauma patients
  • Examples of  further work could include the use of a stepwise sequential protocol, having trauma induced coagulopathy as an inclusion criteria, and the use in TBI