A Systems-Based Approach To Improve Fibrinogen Testing And Treatment Of Low Fibrinogen In Patients Receiving Massive Transfusions: A Quality Improvement Initiative

Background: Uncontrolled hemorrhage is the most common treatable cause of death and four of every ten trauma patients die as a results of exsanguination, or its late effects (Curry et al. Scand J Trauma 2014). There is an increasing understanding of the state of acute coagulopathy and the role that fibrinogen plays in major hemorrhage (Wikkelso A et al. Cochrane Syst Rev 2013). Fibrinogen is a critical protein for hemostasis and clot formation. Low fibrinogen is a risk factor for hemorrhage in patients with major hemorrhage including surgical, obstetrics and trauma patients. Observational studies have reported improved survival with higher fibrinogen:RBC transfusion ratios in trauma.At Regions Hospital, St. Paul, MN, the Transfusion Committee observed that many patients receiving massive transfusions did not have fibrinogen activity tested.