Life-saving blood loss research

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Research conducted at C4TS over the last 10 years has helped to halve death rates among the most critical patients. Here we look at their research into blood loss; the most common preventable cause of death in people with major injuries. 

Trauma: a growing crisis 

Serious injury to the body (medically referred to as ‘trauma’) claims 17,000 lives in the UK every year and experts expect this figure to grow. Some of the most common causes are road traffic accidents and falls from height – incidents which people often class as accidents with the belief that survival is purely down to chance. 

But researchers at the Centre for Trauma Sciences (C4TS) whom we are supporting through our Trauma appeal, are removing chance from the equation. They are discovering what happens to our bodies when we suffer a major injury, and what can be done in the first moments of treatment to help more people survive and leave fewer survivors with life-limiting disabilities. 

Bleeding to death 

Uncontrolled bleeding (also known as haemorrhage) is the most common preventable cause of death in people with major injuries, affecting over 7,000 people nationally each year.  “As many as four in every ten patients affected by severe trauma die from uncontrolled bleeding," says Dr Davenport, the Principal Investigator at C4TS.

Investigating further, Dr Davenport and the team at C4TS found that after serious injury, the body’s normal response to blood loss fails, and patients are unable to form blood clots as normal. 

The key to clotting? 

Fibrinogen is a clotting protein normally found in the bloodstream, which acts as the ‘glue’ which holds a blood clot together. The researchers found that many trauma patients had low levels of fibrinogen and were less likely to survive from their injuries and more likely to ‘bleed out’.

Cryoprecipitate is a frozen blood product and a concentrated source of fibrinogen. The team suspected that by transfusing cryoprecipitate within the first 90 minutes after injury, fibrinogen levels would be replaced in bleeding trauma patients, improving their blood clotting, reducing bleeding and consequently saving lives. They needed to carry out trials on trauma patients in order to confirm this, however.  

The CRYOSTAT trials: Early findings 

The CRYOSTAT trials were designed to answer a simple research question:  would administering cryoprecipitate in addition to current treatments help to improve survival rates in patients with major bleeding? Taking place in 2013 and funded by Barts Charity, CRYOSTAT-1 was a feasibility study at two Major Trauma Centres - The Royal London Hospital and John Radcliffe Hospital, Oxford.

Trauma research like this often takes place in challenging conditions. In this case, researchers got a bleep when potential participants were brought in to the hospitals' trauma units and conducted their tests when patients were extremely sick. Parts of the study also took place at Camp Bastion in Afghanistan, the first military-civilian crossover study of its kind.

The research team showed that by transfusing cryoprecipitate into patients early in their treatment, fibrinogen levels could be maintained and this had potential to halve the number of deaths from trauma haemorrhage. Following these encouraging results, Barts Charity awarded £500,000 to C4TS and NHS Blood and Transplant, which alongside funding from the National Institute of Health Research, allowed the researchers to begin CRYOSTAT-2; a large landmark international clinical trial. 

CRYOSTAT-2 and its potential impact 

Launched in 2017 and running for three years, CRYOSTAT-2 is testing 1,568 severely injured trauma patients from every Major Trauma Centre across the UK, as well as several European and US centres. CRYOSTAT- 2 will provide the answer to whether early delivery of cryoprecipitate, used in addition to standard therapy, prevents deaths from major traumatic bleeding.

If proven successful, the results from this trial will immediately inform practice both nationally and internationally, helping to save the lives of patients who find themselves in the trauma unit. “Improved transfusion practices have the potential to save millions of lives globally,” adds Dr Davenport. 

Working to Transform Trauma 

Barts Charity is fighting for a world where no life is destroyed by major injury. Our Trauma Appeal aims to raise £1 million for trauma care and research projects like this.

Trauma Appeal: Find out more