Haemorrhagic death from severe liver trauma has decreased in the era of haemostatic resuscitation.

BACKGROUND Severe liver trauma can cause major haemorrhage and death. Haemostatic resuscitation principles are associated with improved survival in trauma patients with major haemorrhage. We hypothesised death from liver haemorrhage decreased in parallel with the introduction of haemostatic resuscitation. AIM To establish the incidence of haemorrhagic death in patients with severe liver trauma and review how outcomes in two time periods associate with changes in resuscitation practice. METHODS A retrospective review of all adult patients admitted to Auckland City Hospital with liver trauma was undertaken for a 14-year period. Resuscitation fluid for patients with grade V liver trauma or death from liver haemorrhage was compared between the first and second half of the study (2006-2013 vs. 2013-2020). RESULTS Four hundred and fifty patients were admitted with liver trauma during the 14-year period. Mortality from haemorrhage in patients with severe liver trauma (grade IV and V) decreased between the first and second half of the study (p = 0.009). Pre-hospital and emergency department crystalloid fluid use decreased (p = 0.002). Fresh frozen plasma in ED (p = 0.076) and total cryoprecipitate use (p = 0.072) increased. Tranexamic acid use increased (p = 0.002). Use of colloid fluid was abandoned (p = 0.013). There was no significant difference in pre-hospital time or time from hospital arrival until haemorrhage control laparotomy. CONCLUSION Death from liver haemorrhage decreased in association with the introduction of haemostatic resuscitation while the incidence, severity and surgical management of liver trauma was comparable.