Cryo on call: Pathogen-reduced cryoprecipitated fibrinogen complex is associated with improved fibrinogen supplementation in hemorrhaging trauma patients.

Abstract

Fibrinogen supplementation (FS) is commonly achieved with cryoprecipitate, although the required on-demand thawing often results in delayed FS. Pathogen-reduced cryoprecipitated fibrinogen complex (INTERCEPT fibrinogen complex [IFC]), a novel product, can be stored thawed for up to 5 days, allowing for immediate availability. We hypothesized that IFC implementation at our level 1 trauma center would be associated with increased likelihood of FS, decreased mortality, and transfusion requirement (TR). This was a retrospective review from a single level 1 trauma center from 2022 to 2024, spanning 1 year pre- and post-IFC implementation. Adults who received >900 mL of red blood cells and/or whole blood (WB) within 1 hour were included to identify patients who reached critical administration threshold, indicating significant hemorrhage, without excluding those being resuscitated primarily with WB. Multiple logistic regression assessed the independent effect of IFC implementation on the likelihood of FS and 24-hour mortality. Linear regression modeled TR. In 294 included patients, 24.1% received FS (21.4% pre-IFC, 26.6% post-IFC, p = 0.299). Post-IFC patients tended to be older (44 vs. 39, p = 0.011) and had blunt trauma more often (67.5% vs. 53.6%, p = 0.009), lower shock index (0.87 vs. 0.99, p = 0.004), higher rates of WB use (72.1% vs. 37.9%, p < 0.001), and lower 4-hour TR (2.0 vs. 2.4 L, p = 0.027) but similar ISS, GCS, base deficit, and hematocrit. After controlling for these differences, IFC implementation was associated with increased likelihood of FS (adjusted odds ratio, 2.45; 95% confidence interval, 1.05-5.74), but not with 24-hour mortality or 4-hour TR. Although not statistically significant, there was a trend to earlier FS (median, 67 vs. 42 minutes; p = 0.070; rates of FS within 60 minutes, 40.0% vs. 63.4%; p = 0.051). INTERCEPT fibrinogen complex implementation at our level 1 trauma center was independently associated with FS, but not mortality or TR. Hemorrhaging patients with hypofibrinogenemia, a time-sensitive predictor of mortality in trauma, may benefit from IFC. Prognostic and Epidemiological; Level III.