Uses of Fibrinogen Concentrate in Management of Trauma-Induced Coagulopathy in the Prehospital Environment: A Scoping Review.

Abstract

Objectives: Trauma-induced coagulopathy remains a significant contributor to mortality in severely injured patients. Fibrinogen is essential for early hemostasis and is recognized as the first coagulation factor to fall below critical levels, compromising the coagulation cascade. Recent studies suggest that early administration of fibrinogen concentrate is feasible and effective to prevent coagulopathy. We conducted a scoping review to characterize the existing quantity of literature and to explore the usage of prehospital fibrinogen concentrate products in improving clinical outcomes in trauma patients.

Methods: A search strategy was developed and underwent Peer Review of Electronic Search Strategies (PRESS) review in consultation with an information specialist. We searched MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, and Scopus from inception to May 6, 2024. English studies evaluating prehospital civilian and military usage of fibrinogen concentrate in trauma patients were included. Studies were assessed by three independent reviewers for meeting inclusion and exclusion criteria. A hand search of the reference lists of included articles was conducted to identify additional studies meeting inclusion criteria. Clinical endpoints regarding fibrinogen were extracted and synthesized.

Results: The literature search returned 1,301 articles with six studies meeting the inclusion criteria. Five studies (83%) were conducted in civilian settings and one study (17%) was conducted in a military setting. Of the included studies, two related studies (29%) utilized a randomized control trial design. We identified five outcomes that compared fibrinogen concentrate to a placebo group. The outcomes included thromboembolic events, clotting time, maximum clot firmness, clot stability at emergency department (ED) admission, and fibrinogen concentration at ED admission. Apart from thromboembolic events, all other reported outcomes showed statistically significant differences in group comparisons, determined using p values. The four (67%) non-clinical studies underscored the robustness, practicality, and degree of fibrinogen concentrate utilization in military environments and retrieval services.

Conclusions: Preliminary research suggests that prehospital fibrinogen concentrate administration in traumatic bleeding patients is both feasible and effective, improving clotting parameters. While implementing a time-saving and proactive approach with fibrinogen holds potential for enhancing trauma care, the current evidence is limited. Further studies in this novel field are warranted.