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“ACTIVATION OF COAGULATION & INFLAMMATION IN TRAUMA”
BACKGROUND
In recent decades the implementation of coordinated trauma systems and refinement of trauma resuscitation has allowed critically injured patients who might otherwise have died, to reach hospital and receive life-saving treatment. Trauma hemorrhage remains the biggest preventable cause of death in severely injured patients, being responsible for more than 40% of fatalities within the first few hours of injury.
Even in early survivors of trauma, a cascade of emergent life-threatening medical problems can begin with severe hemorrhage as the result of dysfunctional coagulation (termed Coagulopathy), adverse oxygen supply to tissues (i.e. shock) and inflammation. Death may still ensue within weeks of injury due to a progressive failure of body systems, termed multiple organ failure (MOF).
There is a significant body of fundamental science and clinical evidence in the field of sepsis that implicates the dysregulation of the coagulation and inflammatory systems in the development of MOF. The mechanisms of the body’s acute and protracted response to injury haemorrhage and shock and their cumulative relationship to poorer patient outcomes has yet to be delineated.
AIMS
The key objectives of the ACIT study are to:
  • Identify the clinically significant mechanisms and signaling pathways by which coagulation and inflammation are activated immediately following traumad
  • Elucidate the effect of derangements of coagulation, fibrinolysis, circulating and endothelial cell function on the inflammatory response that result in adverse outcomes in terms of transfusion requirements, organ injury and death
  • Standardize the collection of tissue samples to conduct proteomic and genomic profiling, identifying and exploiting markers of genetic susceptibility and targets for drug discovery to improve trauma patient outcomes
  • Establish an international representative dataset of trauma subjects for the development of translational clinical trials to enhance global trauma patient care
METHODOLOGY
Since being initiated in 2008, the ongoing observational ACIT study has served as an international platform for the enrolment of over 3500 adult trauma patients in the Emergency Department setting, and the standardized collection of clinical data and blood samples.
Multiple analyses to describe the body’s response to injury and blood transfusion therapy are supported from these study materials that capture:
  • Patient age, gender and demographics
  • Pre-hospital and Admission vital signs
  • Mechanism and severity of injury
  • Measures of tissue hypoperfusion
  • Laboratory and clinical assessments from Admission to Discharge/Day28
  • Quantity and timing of blood product, procoagulant & fluid administration
  • In-hospital outcomes and 12-month survival
The ACIT protocol is freely available upon request by email to:
s.eaglestone@qmul.ac.uk