The world of blood

Often it is only a moment. A wrong step, a deep fall. A construction worker is taken to the accident hospital under flashing lights after a serious accident at work. He loses a lot of blood. The team on site has been warned in advance by the rescue service and is already waiting for the arrival. Decisions have to be made quickly. The takeover works like a rehearsal, everyone has their role. Blood is taken from the patient. One sample goes to the laboratory immediately, another is fed directly into a device in the shock room. It takes a few moments until the first results are available, then the experts know what to do.

The scenario described is exemplary for the numerous seriously injured people who are treated in the shock room of Salzburg General Hospital. Whether it is a fall on a construction site, on a mountain or a serious traffic accident – patients are in the best hands at Salzburg General Hospital. This is also shown by a look at the trauma register, a central database of hundreds of hospitals in German-speaking countries. Patients who are admitted to the Salzburg University Hospital with the most serious injuries have above-average chances of survival.

The implementation of bleeding management at the highest international level is one of the outstanding achievements of the Salzburg team and one of Priv.-Doz. Dr. Herbert Schöchl’s greatest successes. Schöchl is a specialist in anaesthesiology and intensive care medicine, AUVA coagulation officer, senior physician at Salzburg UKH and deputy head of the Department of Anaesthesiology and Intensive Care Medicine there since 2018. After more than 20 years of service at AUVA, he is currently performing his last service before taking his well-deserved retirement. Before that, he had worked for almost just as long in his role as an emergency doctor on the Salzburg rescue helicopter and on the emergency ambulance of the city of Salzburg. Hence, he knows the phases of an emergency in all its settings, from the accident scene to the shock room. At some point in their careers, most physicians decide between clinical practice and research. Both are full-time professions. Herbert Schöchl, who always got the best out of himself and his team, left his mark in both areas.

Haemostaseology, i.e. the study of blood coagulation and how it can be influenced, had taken a fancy to him early on and through his tireless commitment he was able to significantly shape this medical field and the research in it over the years.

Herbert Schöchl first got in touch with research in 2009 at the Ludwig Boltzmann Institute for Traumatology (abbreviated to “LBI Trauma”), the research centre in cooperation with AUVA. He was one of the first doctors to hold the then recently created research rotation position in the medical directorate. His very first scientific study was to prove groundbreaking. In it, he described the phenomenon of hyperfibrinolysis, a dangerous complication of blood clotting after severe injuries, and how it can be detected as quickly as possible. In hyperfibrinolysis, the life-saving blood clot that was formed to close a wound from the inside and stop the bleeding dissolves too quickly. Responsible for this is an actually vital mechanism in the body that protects us from dangerous thromboses under normal circumstances. In the case of a serious injury, however, this mechanism can be our fatal fate.

In 2009, the phenomenon of hyperfibrinolysis was still poorly understood. The research world had only just begun to take a closer look at it. Herbert Schöchl’s extensive work, which was characterised by its practical relevance, was co-founding for a topic that was to turn out to be an extremely important aspect of bleeding management in the world’s emergency rooms in the following years.

Spurred on by the valuable findings, Schöchl delved deeper into research on this topic. He founded the research group for trauma-induced coagulation disorders (TIC) at LBI Trauma and thus also paved the way for the “Austrian Way” of bleeding management.

The “Austrian Way”, as it has been christened in the international literature, is characterised by several key points. Each case has to be considered separately, measurements taken directly on the patient and the use of algorithms are the key to personalised, targeted therapy.  The team performs on-site blood clotting tests in the shock room to understand which parts of the blood the patient is missing at that moment. Then the individual components are administered in a targeted manner. The Austrian Way is a step back from the watering can or bucket principle, in which blood transfusions are administered in large quantities. A blood transfusion always represents a liquid transplant – as with any transplant, it can also lead to immune reactions that further weaken the patient’s body. A targeted therapy with red blood cells and clotting factors not only saves the valuable commodity of blood reserves, but also offers severely injured patients higher chances of survival in some situations.

“Herbert always got the best out of the people he worked with. The top priority was always to share the world’s best methods with his patients,” recalls Johannes Zipperle from LBI Trauma, a long-time companion of his scientific work. Schöchl always sought to share his findings with others. He contributed to more than 200 studies in scientific journals – and left behind for posterity a work in the renowned journal Nature Disease Primers, which is considered a standard work for future doctors and experts in the field. In addition, there is his commitment to promoting young talent. “It is estimated that a quarter of all emergency physicians in Austria learned from Herbert,” jokes a colleague at Schöchl’s farewell symposium in Salzburg.  However, he wants to continue holding the courses. After a life dedicated to intensive care medicine, it is probably not too easy to come to a complete rest. And yet the retreat from the clinic gives new space. “True scientific renewal in medicine happens through retirements,” Herbert Schöchl concluded with a smile, his speech at the farewell symposium, causing a few laughs in the audience. We thank Dr. Schöchl for his many years of indispensable work for his patients and his scientific legacy, which will live on beyond his active years.