Publications by authors named "Bernhard Ziegler"

16 Publications

  • Page 1 of 1

Operability of a Resonance-Based Viscoelastic Haemostatic Analyzer in the High-Vibration Environment of Air Medical Transport.

J Clin Med 2022 Jun 23;11(13). Epub 2022 Jun 23.

Ludwig Boltzmann Institute for Traumatology, The Research Center in Cooperation with AUVA, 1200 Vienna, Austria.

Trauma and bleeding are associated with a high mortality, and most of these deaths occur early after injury. Viscoelastic haemostatic tests have gained increasing importance in goal-directed transfusion and bleeding management. A new generation of small-sized and thus portable ultrasound-based viscoelastic analysers have been introduced in clinical practice. We questioned whether a promising candidate can be used in emergency helicopters, with a focus on the susceptibility to vibration stress. We investigated whether the high vibration environment of an emergency helicopter would affect the operability of an ultrasound-based viscoelastic analyser and would yield reproducible results in flight and on the ground. We drew blood from 27 healthy volunteers and performed simultaneous analyses on two TEG 6s. Each measurement was performed in-flight on board an Airbus H135 emergency helicopter and was repeated on the ground, close to the flight area. Results from both measurements were compared, and the recorded tracings and numeric results were analysed for artifacts. Vibratometric measurements were performed throughout the flight in order to quantify changes in the magnitude and character of vibrations in different phases of helicopter operation. The high vibration environment was associated with the presence of artifacts in all recorded tracings. There were significant differences in citrated Kaolin + Heparinase measurements in-flight and on the ground. All other assays increased in variability but did not show significant differences between the two time points. We observed numerous artifacts in viscoelastic measurements that were performed in flight. Some parameters that were obtained from the same sample showed significant differences between in-flight and on-ground measurements. Performing resonance-based viscoelastic tests in helicopter medical service is prone to artifacts. However, a 10 min delay between initiation of measurement and take-off might produce more reliable results.
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http://dx.doi.org/10.3390/jcm11133630DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9267152PMC
June 2022

Thromboelastometry fails to detect autoheparinization after major trauma and hemorrhagic shock.

J Trauma Acute Care Surg 2022 03;92(3):535-541

From the Ludwig Boltzmann Institute for Experimental and Clinical Traumatology (J.Z., D.O., C.J.S., N.H., G.I., M.O., H.S.), AUVA Trauma Research Centre, Vienna; Department of Anaesthesiology and Intensive Care Medicine (D.O., N.W., W.V., H.S.), AUVA Trauma Centre Salzburg, Academic Teaching Hospital of the Paracelsus Medical University, Salzburg, Austria; Paracelsus Medical University (N.W.), Salzburg; Department of Anaesthesiology and Intensive Care Medicine (C.J.S.), AUVA Trauma Centre Linz, Linz; Department of Anaesthesiology, Perioperative Medicine and General Intensive Care Medicine (B.Z.), Paracelsus Medical University, Salzburg, Austria; and Department of Anaesthesiology (O.G.), RWTH Aachen University Hospital, Aachen, Germany.

Background: Heparan sulfate is an integral component of the glycocalyx that provides an anticoagulant layer close to the endothelium. Hypoperfusion, inflammation, and sympathoadrenal activation following major trauma result in glycocalyx shedding and subsequent release of heparan sulfate into the bloodstream. The possible anticoagulant effect of this "autoheparinization" has been suggested as a potential driver of trauma-induced coagulopathy. We investigated whether thromboelastometry can be used to detect trauma-induced autoheparinization.

Methods: This study comprised three parts. First, in a retrospective clinical study of 264 major trauma patients, the clotting time (CT) in the intrinsic activation (INTEM) and intrinsic activation plus heparinase (HEPTEM) assays were evaluated upon emergency room admission. Second, in an in vivo experimental rat model of hemorrhagic-traumatic shock, the release of heparan sulfate was investigated with INTEM and HEPTEM analyses of whole blood. Third, in vitro spiking of whole blood from healthy volunteers was undertaken to assess the effects of clinically relevant quantities of heparan sulfate and heparin on CT in the INTEM and HEPTEM assays.

Results: In the first part, severe injury and hemorrhagic shock was not associated with any increases in INTEM CT versus HEPTEM CT. Part 2 showed that an approximate threefold increase in heparan sulfate resulting from hemorrhagic traumatic shock in rats did not prolong INTEM CT, and no significant differences between INTEM CT and HEPTEM CT were observed. Third, spiking of whole blood with heparan sulfate had no impact on INTEM CT, whereas heparin elicited significant prolongation of INTEM CT.

Conclusion: Despite structural similarity between heparan sulfate and heparin, the amounts of heparan sulfate shed in response to trauma did not exert an anticoagulant effect that was measurable by the intrinsically activated CT in thromboelastometry. The extent to which heparan sulfate contributes to trauma-induced coagulopathy has yet to be elucidated.

Level Of Evidence: Prognostic and Epidemiologic; Level III.
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http://dx.doi.org/10.1097/TA.0000000000003464DOI Listing
March 2022

More Than 500 Kids Could Be Saved Each Year! Ten Consensus Actions to Improve Quality of Pediatric Resuscitation in DACH-Countries (Austria, Germany, and Switzerland).

Front Pediatr 2020 7;8:549710. Epub 2020 Oct 7.

Dr. von Hauner University Children's Hospital, Ludwig-Maximilians-University Munich, Munich, Germany.

• Quality and outcome of pediatric resuscitation often does not achieve recommended goals. • Quality improvement initiatives with the aim of better survival rates and decreased morbidity of resuscitated children are urgently needed. • These initiatives should include an action framework for a comprehensive, fundamental, and interprofessional reorientation of clinical and organizational structures concerning resuscitation and post-resuscitation care of children. • The authors of this DACH position statement suggest the implementation of 10 evidence-based actions (for out-of-hospital and in-house cardiac arrests) that should improve survival rates and decrease morbidity of resuscitated children with better neurological outcome and quality of life.
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http://dx.doi.org/10.3389/fped.2020.549710DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7575775PMC
October 2020

Efficacy of prehospital administration of fibrinogen concentrate in trauma patients bleeding or presumed to bleed (FIinTIC): A multicentre, double-blind, placebo-controlled, randomised pilot study.

Eur J Anaesthesiol 2021 04;38(4):348-357

From the Department of Anaesthesiology, Perioperative Medicine and General Intensive Care Medicine, Paracelsus Medical University, Salzburg (BZ), Department of General and Surgical Critical Care Medicine, (MB, BS, DF ), Department of Anaesthesiology and Intensive Care Medicine (HH, PI, MK, EO, MT, BT), Department of Pediatrics, Pediatrics I, Intensive Care Unit, Medical University of Innsbruck, Innsbruck (CN), Department of Mathematics, Faculty of Mathematics, Computer Science and Physics, University of Innsbruck, Technikerstrasse, Austria (TH), Department of Trauma and Orthopedic Surgery, Cologne-Merheim Medical Center (CMMC), University Witten/Herdecke (UW/H), Campus Cologne-Merheim, Cologne, Germany (MM), Institute of Thrombosis and Haemostasis and the National Haemophilia Centre, The Chaim Sheba Medical Centre, Tel Hashomer, Israel (UM), Sportclinic Zillertal GmbH, Mayrhofen, Austria (CN), Department of Anaesthesiology and Intensive Care Medicine, AUVA Trauma Centre Salzburg, Academic Teaching Hospital of the Paracelsus Medical University, Salzburg, Austria (HS, WV), Department of Anesthesiology and Intensive Care, Liberec Regional Hospital, Liberec, Czech Republic (IZ), Christophorus 14, Niederöblarn, Austria (CW).

Background: Trauma-induced coagulopathy (TIC) substantially contributes to mortality in bleeding trauma patients.

Objective: The aim of the study was to administer fibrinogen concentrate in the prehospital setting to improve blood clot stability in trauma patients bleeding or presumed to bleed.

Design: A prospective, randomised, placebo-controlled, double-blinded, international clinical trial.

Setting: This emergency care trial was conducted in 12 Helicopter Emergency Medical Services (HEMS) and Emergency Doctors' vehicles (NEF or NAW) and four trauma centres in Austria, Germany and Czech Republic between 2011 and 2015.

Patients: A total of 53 evaluable trauma patients aged at least 18 years with major bleeding and in need of volume therapy were included, of whom 28 received fibrinogen concentrate and 25 received placebo.

Interventions: Patients were allocated to receive either fibrinogen concentrate or placebo prehospital at the scene or during transportation to the study centre.

Main Outcome Measures: Primary outcome was the assessment of clot stability as reflected by maximum clot firmness in the FIBTEM assay (FIBTEM MCF) before and after administration of the study drug.

Results: Median FIBTEM MCF decreased in the placebo group between baseline (before administration of study treatment) and admission to the Emergency Department, from a median of 12.5 [IQR 10.5 to 14] mm to 11 [9.5 to 13] mm (P = 0.0226), but increased in the FC Group from 13 [11 to 15] mm to 15 [13.5 to 17] mm (P = 0.0062). The median between-group difference in the change in FIBTEM MCF was 5 [3 to 7] mm (P < 0.0001). Median fibrinogen plasma concentrations in the fibrinogen concentrate Group were kept above the recommended critical threshold of 2.0 g l-1 throughout the observation period.

Conclusion: Early fibrinogen concentrate administration is feasible in the complex and time-sensitive environment of prehospital trauma care. It protects against early fibrinogen depletion, and promotes rapid blood clot initiation and clot stability.

Trial Registry Numbers: EudraCT: 2010-022923-31 and ClinicalTrials.gov: NCT01475344.
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http://dx.doi.org/10.1097/EJA.0000000000001366DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7969176PMC
April 2021

Comparison of fresh frozen plasma vs. coagulation factor concentrates for reconstitution of blood: An in vitro study.

Eur J Anaesthesiol 2020 10;37(10):879-888

From the Department of Anaesthesia, Critical Care and Pain Medicine, Medical University of Vienna (JG), Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Trauma Research Centre Vienna, Vienna, Austria (MP, CJS, JZ, DO, HS, CG), Department of Anesthesiology and Intensive Care Medicine, AUVA Trauma Centre Linz, Linz, Austria (MP, CJS), Department of Anaesthesia and Intensive Care Medicine, Humanitas Clinical and Research Center, Rozzano, Italy (GEI), Department of Laboratory Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria (JC), Department of Anesthesiology, University Hospital of the RWTH Aachen, Aachen, Germany (OG), Department of Blood Group Serology and Transfusion Medicine, Medical University of Graz, Graz (CG), Formerly: Red Cross Transfusion Service of Upper Austria, Linz (CG), Department of Anaesthesiology and Intensive Care Medicine, University Hospital Salzburg (BZ), Department of Anaesthesia and Intensive Care Medicine, AUVA Trauma Centre Salzburg, Academic Teaching Hospital of the Paracelsus Medical University Salzburg, Salzburg (HS).

Background: Many trauma centres have adopted the administration of fixed ratios of packed red blood cells (PRBCs), platelet concentrates and fresh frozen plasma (FFP) for bleeding patients. However, the haemostatic efficacy of this concept is not well proven.

Objective: Our objective was to characterise the haemostatic profile of different ratios (2 : 1 : 1, 1 : 1 : 1 and 1 : 1 : 2) of PRBCs, platelet concentrates and FFP in comparison with coagulation factor concentrates (fibrinogen and/or prothrombin complex concentrate).

Design: An in vitro study.

Setting: Research laboratories of the department of transfusion medicine, Linz, Austria.

Materials: Whole blood donations from a total of 20 male volunteers.

Intervention: Reconstitution of blood at different ratios of PRBCs, platelet concentrates and FFP or coagulation factor concentrates.

Main Outcome Measures: Cell count, conventional and thromboelastometric coagulation parameters, single coagulation factor activities as well as endogenous thrombin potential.

Results: Fibrinogen levels and haematocrit were lower in the FFP group at any ratio compared with the concentrate-based groups (P < 0.0001). Reconstitution of blood with FFP at different ratios resulted in haematocrit or fibrinogen levels that were borderline with regard to recommended substitution triggers (haematocrit 41 ± 2% and fibrinogen 1.5 ± 0.3 g l at the 2 : 1 : 1 ratio vs. 21 ± 1% and 2.1 ± 0.4 g l respectively at the 1 : 1 : 2 ratio). Compared with FFP at any ratio, maximum clot firmness showed higher values in the groups using fibrinogen concentrate (P < 0.0001), whereas endogenous thrombin potential revealed higher values in the groups using prothrombin complex concentrate (P < 0.0001).

Conclusion: Use of coagulation factor concentrates for the reconstitution of blood allows for delivery of a higher haematocrit and a higher fibrinogen content compared with FFP. However, prothrombin complex concentrate might result in an unnecessary excess of thrombin generation. Clinical studies are warranted to further investigate these in vitro findings.
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http://dx.doi.org/10.1097/EJA.0000000000001202DOI Listing
October 2020

Idarucizumab in major trauma patients: a single centre real life experience.

Eur J Trauma Emerg Surg 2021 Apr 25;47(2):589-595. Epub 2019 Sep 25.

Departement of Anaesthesiology and Intensive Care Medicine AUVA Trauma Centre Salzburg, Academic Teaching Hospital of the Paracelsus Medical University, Dr. Franz-Rehrl-Platz 5, 5020, Salzburg, Austria.

Introduction: Trauma care providers are facing an increasing number of elderly patients on direct oral anticoagulants prior to injury. For dabigatran etexilate (DAB), the specific antagonist idarucizumab (IDA) has been approved since 2015 as a reversal agent. However, only limited data regarding the use of IDA in trauma patients are available.

Methods: We performed a retrospective analysis of trauma patients under DAB for whom IDA administration was deemed necessary to reverse DAB's antithrombotic effect.

Results: A total of 15 (9 male) patients were treated with IDA during the study period. The mean age was 81 ± 10 years. Intracranial haemorrhage (n = 7) and long bone fractures (n = 5) were the most common types of injury. Three patients were diagnosed as polytrauma. In all but one patient, atrial fibrillation was the indication for DAB intake. The median dose of IDA was 2.5 g (IQR 2.5-5). IDA administration decreased DAB plasma levels from 112.4 (IQR 73.4-123.4) to 5 (IQR 4-12) ng/mL (p = 0.031), thrombin time from 114.8 ± 48.3 to 16.2 ± 0.5 s (p < 0.0001) and activated partial thromboplastin time form 45.4 ± 11.3 to 34.2 ± 7.0 s (p = 0.0025). No thromboembolic events or side effects attributed to IDA were observed. All patients survived until hospital discharge.

Conclusions: In trauma patients under DAB prior to injury, IDA decreased DAB plasma levels and normalized coagulation parameters. IDA appears to be safe, and no serious side effects were observed in this small cohort of patients.
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http://dx.doi.org/10.1007/s00068-019-01233-yDOI Listing
April 2021

Comparison between the new fully automated viscoelastic coagulation analysers TEG 6s and ROTEM Sigma in trauma patients: A prospective observational study.

Eur J Anaesthesiol 2019 Nov;36(11):834-842

From the Departement of Anesthesiology and Intensive Care Medicine, University Hospital of Salzburg (BZ), Departement of Anesthesiology and Intensive Care Medicine, AUVA Trauma Centre Salzburg, Academic Teaching Hospital of the Paracelsus Medical University, Salzburg (WV, HS), Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Trauma Research Centre, Vienna, Austria (JZ, HS) and Department of Anesthesiology, RWTH Aachen University Hospital, Aachen, Germany (OG).

Background: Viscoelastic coagulation testing is increasingly used to diagnose trauma-induced coagulopathy. Two fully automated analysers, TEG 6s and ROTEM Sigma, were launched recently. No previous studies have compared these devices in trauma paients.

Objective: The aim of this study was to evaluate whether both fully automatic devices deliver comparable results.

Design: Prospective observational study.

Setting: Level one trauma centre from August 2017 to September 2018.

Patients: A total of 105 blood samples from 67 trauma patients were analysed simultaneously on TEG 6s and ROTEM Sigma.

Main Outcome Measures: TEG 6s assays kaolin (CK), RapidTEG (CRT), kaolin with heparinase (CKH) and functional fibrinogen were compared with ROTEM Sigma assays INTEM, EXTEM, HEPTEM and FIBTEM. TEG 6s functional fibrinogen level was compared with plasma fibrinogen concentration, measured using the Clauss method. Correlations were classified as weak (Spearman correlation coefficient 0.20 to 0.39), moderate (0.40 to 0.59), strong (0.60 to 0.79) or very strong (≥0.80).

Results: The TEG 6s parameters reaction time, kinetic time and α-angle (CK, CRT and CKH assays) mostly showed strong correlations with the corresponding ROTEM parameters clotting time, clot formation time and α-angle (INTEM, EXTEM and HEPTEM assays). The exceptions were CRT reaction time vs. EXTEM clotting time, and CK α-angle vs. INTEM α-angle, which correlated moderately. Absolute values for many of these parameters showed significant differences between the two devices. Very strong correlations and similar absolute values were observed between TEG 6s maximum amplitude (CRT, CK and CKH assays) and ROTEM maximum clot firmness (EXTEM, INTEM and HEPTEM assays). Correlations were also very strong for functional fibrinogen maximum amplitude vs. FIBTEM maximum clot firmness and functional fibrinogen level vs. Clauss fibrinogen concentration, but absolute values were significantly different.

Conclusion: Strong to very strong correlations were observed between corresponding TEG 6s and ROTEM Sigma parameters. However, absolute values showed significant differences for most of the measurements.
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http://dx.doi.org/10.1097/EJA.0000000000001032DOI Listing
November 2019

Ambu® Aura Gain™ versus Ambu® Aura Once™ in children: a randomized, crossover study assessing oropharyngeal leak pressure and fibreoptic position.

Can J Anaesth 2019 01 12;66(1):57-62. Epub 2018 Oct 12.

Department of Anaesthesia and Intensive Care, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.

Purpose: The Ambu® Aura Gain™ is a new second-generation supraglottic airway device that-because of a wider curvature and a wide airway tube-allows fibreoptic intubation. The purpose of this study was to assess the oropharyngeal leak pressure of the Ambu® Aura GainTM compared with the Ambu® Aura Once™.

Methods: In this randomized non-blinded crossover trial with 50 patients aged 18 months to six years (10-20 kg), we compared the Ambu® Aura Gain™ and the Ambu® Aura Once™ for airway maintenance in anesthetized, non-paralyzed participants. Our primary outcome was oropharyngeal leak pressure. Time of insertion, success rates for each device, evaluation of fibreoptic view and ventilation quality during anesthesia, as well as possible complications (e.g., blood staining) were assessed.

Results: There were no differences in first and overall insertion attempt rates (Ambu® Aura Once™ 50/50 (100%) vs Ambu® Aura Gain™ 50/50 (100%). Mean (standard deviation) oropharyngeal leak pressure was found to be significantly higher for Ambu® Aura Gain™ than it was for Ambu® Aura Once™ [21 (7) vs 19 (6) cmHO, respectively; mean difference [MD] - 2 cmHO; 95% confidence interval [CI], - 3.8 to - 1.0; P = 0.001]. Mean (SD) insertion time was faster for Ambu® Aura Once™ than for Ambu® Aura Gain™ [8 (3) vs 10 (4) seconds, respectively; MD, - 2 sec; 95% CI, - 2.9 to - 1.2; P < 0.001]. There were no differences in ventilation quality, fibreoptic view, or blood staining.

Conclusion: We conclude that Ambu® Aura Gain™ is a good alternative to the Ambu® Aura Once™ and an efficient device for children in this age group.

Trial Registration: www.clincaltrials.gov (NCT02811042). Registered 23 June 2016.
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http://dx.doi.org/10.1007/s12630-018-1235-7DOI Listing
January 2019

Impact of Direct Oral Anticoagulants in Patients With Hip Fractures.

J Orthop Trauma 2019 Jan;33(1):e8-e13

Department of Anaesthesiology and Intensive Care Medicine, AUVA Trauma Center Salzburg, Academic Teaching Hospital, Paracelsus Medical University, Salzburg, Austria.

Objective: To assess the impact of direct oral anticoagulant (DOAC) intake compared with Coumadin (COU) in patients suffering hip fractures (HFs).

Design: Retrospective cohort analysis.

Setting: Level 1 Trauma Center.

Intervention: Timing of surgical hip fixation.

Patients: Three-hundred twenty patients 65 years of age or older with isolated HF were enrolled into the study: 207 (64.7%) without any antithrombotic therapy (no-ATT), 59 (18.4%) on COU, and 54 (16.9%) on DOACs.

Main Outcome Measurements: Time to surgery, blood loss, mortality, hospital length of stay, red blood cell transfusion, use of reversal agents, and Charlson Comorbidity Index.

Results: Patients on COU and DOACs had a higher Charlson Comorbidity Index compared with the no-ATT group (P < 0.0001). Despite the fact that significantly more patients received reversal agents in the COU group compared with DOAC medication (P < 0.0001), percentage of transfused patients were similar (54.2% vs. 53.7%). Time to surgery was significantly shorter in the no-ATT group when compared with DOAC patients (12-29.5 hours, respectively). No difference in postoperative hemorrhage, intensive care unit length of stay, and mortality was observed between groups.

Conclusions: DOAC medication in HF patients caused long elapse time until surgical repair. We found no evidence of higher bleeding rates in HF patients on DOACs compared with COUs. Earlier HF fixation might be indicated in DOAC patients.

Level Of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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http://dx.doi.org/10.1097/BOT.0000000000001329DOI Listing
January 2019

[Reduction the risk in pediatric anesthesia-what should we know-what should we do].

Wien Med Wochenschr 2019 Mar 18;169(3-4):56-60. Epub 2018 Sep 18.

Anästhesieabteilung, Universitäts-Kinderspital Zürich, Zürich, Schweiz.

Pediatric anesthesia has always been conjuncted with higher risk than anesthesia for adults (JP Morray; Pediatric Anesthesia 2011;21:722-9). Not only the imminent critical events, but also, caused by recently published data, the theoretical neurotoxicity of anesthetic agents and a potencial negative influence of anesthetics on braindevelopement, are in the spotlight.Concerns about the neurodevelopement and the general warnings from the U.S. Food and Drug Administration (FDA) for anesthesia in young children led to a worldwide discussion about safety in pediatric anesthesia (FDA Safety Anouncement 2017).Beside these theoretical risks, which are based only on animal research, we have to pay much more attention to the widely spread out poor quality of anesthesia in children.The following article should summarize the state of science about the risks and the opportunities to minimize them.
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http://dx.doi.org/10.1007/s10354-018-0651-1DOI Listing
March 2019

Quantitative Insights into the Fast Pyrolysis of Extracted Cellulose, Hemicelluloses, and Lignin.

ChemSusChem 2017 08 25;10(16):3212-3224. Epub 2017 Jul 25.

European Bioenergy Research Institute, Aston University, Birmingham, B4 7ET, UK.

The transformation of lignocellulosic biomass into bio-based commodity chemicals is technically possible. Among thermochemical processes, fast pyrolysis, a relatively mature technology that has now reached a commercial level, produces a high yield of an organic-rich liquid stream. Despite recent efforts to elucidate the degradation paths of biomass during pyrolysis, the selectivity and recovery rates of bio-compounds remain low. In an attempt to clarify the general degradation scheme of biomass fast pyrolysis and provide a quantitative insight, the use of fast pyrolysis microreactors is combined with spectroscopic techniques (i.e., mass spectrometry and NMR spectroscopy) and mixtures of unlabeled and C-enriched materials. The first stage of the work aimed to select the type of reactor to use to ensure control of the pyrolysis regime. A comparison of the chemical fragmentation patterns of "primary" fast pyrolysis volatiles detected by using GC-MS between two small-scale microreactors showed the inevitable occurrence of secondary reactions. In the second stage, liquid fractions that are also made of primary fast pyrolysis condensates were analyzed by using quantitative liquid-state C NMR spectroscopy to provide a quantitative distribution of functional groups. The compilation of these results into a map that displays the distribution of functional groups according to the individual and main constituents of biomass (i.e., hemicelluloses, cellulose and lignin) confirmed the origin of individual chemicals within the fast pyrolysis liquids.
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http://dx.doi.org/10.1002/cssc.201700984DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5582602PMC
August 2017

Thromboelastometric Monitoring of the Hemostatic Effect of Platelet Concentrates Transfusion in Thrombocytopenic Children Undergoing Chemotherapy.

Clin Appl Thromb Hemost 2015 Sep 18;21(6):558-64. Epub 2014 Dec 18.

Department of Pediatrics, Paracelsus Medical University, Salzburg, Austria.

Prophylactic platelet concentrates transfusion represents a therapeutic choice in patients with chemotherapy-induced thrombocytopenia. This prospective, non-interventional study evaluated the effects of platelet concentrates transfusion on thromboelastometric parameters of platelet function in 36 transfusion occasions for 11 thrombocytopenic children undergoing chemotherapy. Pre- and posttransfusion (1-2 hours) blood samples were analyzed using standard coagulation tests and thromboelastometry (ROTEM) measurements (EXTEM and FIBTEM tests). Platelet component of the clot was calculated based on the EXTEM and FIBTEM maximum clot elasticity (MCE) results. After transfusion, mean platelet count increased from 16.5 × 10(9)/L to 43.0 × 10(9)/L (P < .001) and platelet component increased from 34.1 to 73.0 (P < .001). Statistically significant increases for posttransfusion EXTEM parameters A10, A20, and maximum clot firmness (MCF) were observed compared to pretransfusion values (P < .001). The EXTEM α-angle values increased posttransfusion (P < .05). The FIBTEM measurements were comparable pre- and posttransfusion. The study showed that platelet concentrates transfusion in thrombocytopenic children undergoing chemotherapy improves platelet-related coagulation pattern.
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http://dx.doi.org/10.1177/1076029614564862DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4514819PMC
September 2015

Severe pediatric blunt trauma--successful ROTEM-guided hemostatic therapy with fibrinogen concentrate and no administration of fresh frozen plasma or platelets.

Clin Appl Thromb Hemost 2013 Jul-Aug;19(4):453-9. Epub 2012 Sep 10.

Department of Anaesthesiology, Perioperative Medicine and General Intensive Care, SALK University Hospital, Salzburg, Austria.

Use of allogeneic blood products to treat pediatric trauma may be challenged, particularly in relation to safety. We report successful treatment of a child with severe abdominal and pelvic injuries with preemptive fibrinogen supplementation followed by rotational thromboelastometry (ROTEM)-guided, goal-directed hemostatic therapy. Fibrinogen concentrate was administered (total dose: 2 g), while transfusion of fresh frozen plasma and platelet concentrate was avoided. Activated partial thromboplastin time was prolonged and Quick values were low but ROTEM clotting time values remained normal, therefore, no thrombin-generating drugs were considered necessary. This case shows the potential for hemostatic treatment with coagulation factor concentrates to be applied to pediatric trauma.
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http://dx.doi.org/10.1177/1076029612458149DOI Listing
May 2014

Platelet function following trauma. A multiple electrode aggregometry study.

Thromb Haemost 2011 Aug 9;106(2):322-30. Epub 2011 Jun 9.

Department of Anaesthesiology and Intensive Care Medicine, AUVA Trauma Centre, Salzburg, Austria.

Platelets play a central role in coagulation. Currently, information on platelet function following trauma is limited. We performed a retrospective analysis of patients admitted to the emergency room (ER) at the AUVA Trauma Centre, Salzburg, after sustaining traumatic injury. Immediately after admission to the ER, blood was drawn for blood cell counts, standard coagulation tests, and platelet function testing. Platelet function was assessed by multiplate electrode aggregometry (MEA) using adenosine diphosphate (ADPtest), collagen (COLtest) and thrombin receptor activating peptide-6 (TRAPtest) as activators. The thromboelastometric platelet component, measuring the contribution of platelets to the elasticity of the whole-blood clot, was assessed using the ROTEM device. The study included 163 patients, 79.7% were male, and the median age was 43 years. The median injury severity score was 18. Twenty patients (12.3%) died. Median platelet count was significantly lower among non-survivors than survivors (181,000/μl vs. 212,000/μl; p=0.01). Although platelet function defects were relatively minor, significant differences between survivors and non-survivors were observed in the ADPtest (94 vs. 79 U; p=0.0019), TRAPtest (136 vs. 115 U; p<0.0001), and platelet component (134 vs.103 MCEEXTEM - MCEFIBTEM; p=0.0012). Aggregometry values below the normal range for ADPtest and TRAPtest were significantly more frequent in non-survivors than in survivors (p=0.0017 and p=0.0002, respectively). Minor decreases in platelet function upon admission to the ER were a sign of coagulopathy accompanying increased mortality in patients with trauma. Further studies are warranted to confirm these results and investigate the role of platelet function in trauma haemostatic management.
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http://dx.doi.org/10.1160/TH11-03-0175DOI Listing
August 2011

A comparison of fibrinogen measurement methods with fibrin clot elasticity assessed by thromboelastometry, before and after administration of fibrinogen concentrate in cardiac surgery patients.

Transfusion 2011 Aug 25;51(8):1695-706. Epub 2011 Feb 25.

Department of Anaesthesiology and Intensive Care and the Institute of Medical and Chemical Laboratory Diagnostics, Salzburger Landeskliniken SALK, Salzburg, Austria.

Background: Fibrinogen concentrate administration can be guided by measuring fibrinogen concentration or quality of the fibrin-based clot. This study compared different fibrinogen concentration measurement methods with maximum clot firmness (MCF) of the fibrin clot, assessed by thromboelastometry (FIBTEM), in 33 cardiovascular surgery patients receiving fibrinogen concentrate for hemostatic therapy.

Study Design And Methods: Blood samples were collected after cardiopulmonary bypass (CPB) and after fibrinogen concentrate administration. FIBTEM MCF was measured using a rotational thromboelastometry device (ROTEM, Tem International). Fibrinogen concentration was measured using photo-optical (CA-7000, Siemens Healthcare Diagnostics), mechanical (KC-10 steel ball, Schnitger and Gross hook, Amelung GmbH), and electromechanical (STA-R, Diagnostica Stago) coagulometers. Assessments included agreement between fibrinogen concentration measurements and correlations between fibrinogen concentration and FIBTEM MCF.

Results: After CPB, correlations were significant (p < 0.001) between FIBTEM MCF and fibrinogen concentration determined by steel ball (r = 0.71), hook (r = 0.73), STA-R (r = 0.81), and CA-7000 (r = 0.82) coagulometers. After fibrinogen concentrate administration, agreement between fibrinogen measurement methods was severely impaired, and correlations with FIBTEM MCF were 0.39 (steel ball), 0.33 (hook), 0.59 (STA-R), and 0.33 (CA-7000).

Conclusion: Agreement between fibrinogen concentration measurement methods decreased considerably after fibrinogen concentrate administration. All methods correlated acceptably with FIBTEM MCF at the end of CPB, but not after hemostatic therapy. Further investigation is needed to explain these findings.
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http://dx.doi.org/10.1111/j.1537-2995.2011.03066.xDOI Listing
August 2011

[Coagulation management in trauma-related massive bleeding. - Recommendations of the Task Force for Coagulation (AGPG) of the Austrian Society of Anesthesiology, Resuscitation and Intensive Care Medicine (OGARI)].

Anasthesiol Intensivmed Notfallmed Schmerzther 2010 Sep 13;45(9):552-61. Epub 2010 Sep 13.

Klinische Abteilung für Allgemeine und Chirurgische Intensivmedizin, Medizinische Universität Innsbruck, Osterreich.

Even nowadays and at specialized centers, one of the leading causes of death is exsanguination. Trauma-induced coagulopathy (TIC) occuring with massive blood loss primarily results from loss of coagualtion factors and platelets and is aggravated by hemodilution. In addition, hyperfibrinolysis, hypothermia, acidosis and hypocalcaemia also contribute to the development of severe haemostatic derangement. During the past few years new insights into the pathophysiology of TIC and the widespread use of viscoelastic coagulation monitoring provoked the development of alternative treatment concepts. As for the previously recommended standard therapy using fresh frozen plasma and platelet concentrates also for alternative strategies no data from large prospective randomized studies are available until now, however, the evidence is growing favoring the use of coagulation factor concentrates guided by viscoelastic measurements.
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http://dx.doi.org/10.1055/s-0030-1265746DOI Listing
September 2010
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