“EVEN IN THE 21ST CENTURY in Toronto, trauma patients die of bleeding,” says Dr. Sandro Rizoli, a Sunnybrook associate professor, surgery and critical care. “After a trauma, the clotting system doesn’t work properly,” he explains.
Traditionally, these patients are given a high volume of blood – a treatment called damage-control resuscitation, which became standard in 2007, out of findings from treating traumatic injuries in the Iraq war. But using this method has consequences. “One massive trauma can practically drain the blood bank in Toronto, especially if it’s a rare blood type,” Dr. Rizoli says. “This has a trickle-down effect: someone here for elective surgery can’t have it because there is no blood left.”
With the help of military funding, Dr. Rizoli is studying the reasons trauma patients don’t clot and whether damage-control resuscitation is the best method of treatment. He’s using a ROTEM, a highly sophisticated piece of equipment that tests clotting abilities. Sunnybrook was the first hospital in North America to have the machine; while about 10 hospitals have it now, most use it only for research. “We have special permission to use it for clinical application. The beauty of this is, it’s in the lab, but the results are transmitted in real time to the trauma room and the operating room.”
When a patient arrives in the trauma centre, the ROTEM tests his or her whole clotting system: whether clots are forming, the strength of the clots and how fast the clots are dissolving. It helps the surgeons decide how to treat the patient. This would be beneficial to the military, Dr. Rizoli says, where bleeding is the leading cause of death and blood-bank resources in combat zones are difficult to maintain.
Dr. Rizoli hopes Sunnybrook can become a centre for bleeding studies in the future. “This type of research cannot be done by a single person or even a single department in the hospital,” he says. “It needs a place like Sunnybrook, which has the patients, the research infrastructure and many interested doctors and scientists who work together. Sunnybrook is the ideal place. You cannot even measure the value of the various teams working together.”