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Induced hypothermia does not impair coagulation system in a swine multiple trauma model

Mohr, Juliane MD; Ruchholtz, Steffen MD; Hildebrand, Frank MD; Flohé, Sascha MD; Frink, Michael MD; Witte, Ingo MD; Weuster, Matthias MD; Fröhlich, Matthias MD; van Griensven, Martijn PhD; Keibl, Claudia VMD; Mommsen, Philipp MD

Journal of Trauma and Acute Care Surgery: April 2013 - Volume 74 - Issue 4 - p 1014–1020
doi: 10.1097/TA.0b013e3182826edd
Original Articles

BACKGROUND Accidental hypothermia, acidosis, and coagulopathy represent the lethal triad in severely injured patients. Therapeutic hypothermia however is commonly used in transplantations, cardiac and neurosurgical surgery, or after cardiac arrest. However, the effects of therapeutic hypothermia on the coagulation system following multiple trauma need to be elucidated.

METHODS In a porcine model of multiple trauma including blunt chest injury, liver laceration, and hemorrhagic shock followed by fluid resuscitation, the influence of therapeutic hypothermia on coagulation was evaluated. A total of 40 pigs were randomly assigned to sham (only anesthesia) or trauma groups receiving either hypothermia or normothermia. Each group consisted of 10 pigs. Analyzed parameters were cell count (red blood cells, platelets), pH, prothrombin time (PT), fibrinogen concentration, and analysis with ROTEM and Multiplate.

RESULTS Trauma and consecutive fluid resuscitation resulted in impaired coagulation parameters (cell count, pH, PT, fibrinogen, ROTEM, and platelet function). During hypothermia, coagulation parameters measured at 37°C, such as PT, fibrinogen, thrombelastometry measurements, and platelet function, showed no significant differences between normothermic and hypothermic animals in both trauma groups. Additional analyses of thrombelastometry at 34°C during hypothermia showed significant differences for clotting time and clot formation time but not for maximum clot firmness. We were not able to detect macroscopic or petechial bleeding in both trauma groups.

CONCLUSION Based on the results of the present study we suggest that mild hypothermia can be safely performed after stabilization following major trauma. Mild hypothermia has effects on the coagulation system but does not aggravate trauma-induced coagulopathy in our model. Before hypothermic treatment can be performed in the clinical setting, additional experiments with prolonged and deeper hypothermia to exclude detrimental effects are required.

From the Trauma Department (J.M., S.R., M.F.), University of Giessen-Marburg, Marburg; Trauma Department (F.H., P.M.), Hannover Medical School, Hannover; Trauma Department (S.F., I.W.), University of Düsseldorf, Düsseldorf; Trauma Department (M.W.), University of Schleswig-Holstein, Kiel; Trauma Department (M.F.), University of Aachen, Aachen; and Experimental Trauma Surgery (M.V.G.), Technical University Munich, Munich, Germany; and Ludwig Boltzmann Institute for Experimental and Clinical Traumatology (M.V.G., C.K.), Vienna, Austria.

Submitted: October 14, 2012, Revised: November 30, 2012, Accepted: December 3, 2012.

The study was presented at the (1) Congress of European Federation of National Associations of Orthopaedics and Traumatology (EFORT), Berlin, 2012; and (2) Congress of German Association for Orthopaedics and Traumatology (DKOU), Berlin, 2012.

Address for reprints: Juliane Mohr, MD, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Giessen and Marburg GmbH, Marburg, Baldingerstraße, 35043 Marburg; email:

© 2013 Lippincott Williams & Wilkins, Inc.