The Effect of Shock Duration on Trauma-Induced Coagulopathy in a Murine Model

Background: Trauma-induced coagulopathy (TIC) is a life-threatening condition associated with high morbidity and mortality. TIC can present with different coagulation defects. In this study, the aim was to determine the effect of shock duration on TIC characteristics. We hypothesized that longer duration of shock leads to a more hypocoagulable rotational thromboelastometry (ROTEM) profile compared to a shorter duration of shock. Methods: | Male B57BL/6J(c) mice (n=5 to 10 per group) were sedated and mechanically ventilated. Trauma was induced by bilateral lower limb fractures and crush injuries to the liver and small intestine. Shock was induced by blood withdrawals until a mean arterial pressure of 25-30 mmHg was achieved. Groups reflected trauma and shock for 30 min (TS30) and trauma and shock for 90 min (TS90). Control groups included ventilation only (V90) and trauma only (T90). Results: Shock groups had increased base deficit compared to control groups (V90 and T90). Mortality was 10% in TS30 and 30% in TS90. ROTEM profile was more hypocoagulable, as shown by significantly lower maximum clot firmness (MCF) in the TS30 group (43.5 [37.5 – 46.8] mm) compared to the TS90 group (52.0 [47.0 – 53.0] mm, p=0.008). ROTEM clotting time and parameters of clot build-up did not significantly differ between groups. Conclusions: TIC characteristics change with shock duration. Contrary to the hypothesis, a shorter duration of shock was associated with decreased maximum clotting amplitudes compared to longer duration of shock. The effect of shock duration on TIC should be further assessed in trauma patients.