Translational Anesthesiology and Pain Medicine

Anesthesiologists make a significant contribution to the care and treatment of severely injured patients. Beyond the concept of anesthesia and analgesia, the specialty of anesthesiology focuses on the preservation of vital organ function and pain management in all phases of trauma. In order to provide patients in AUVA hospitals with evidence-based medicine at the highest level and at the cutting edge of science, a research group focusing on coagulopathy and clinical bleeding management was founded at the LBI Trauma in 2009 by anesthesiologist Herbert Schöchl from the AUVA trauma center in Salzburg.  Since then, the group has steadily developed and has been able to significantly shape this field of medicine during this time.

With the beginning of 2023, the research group “Translational Anesthesiology and Pain Medicine” (TAP) was put on a new foundation and expanded to include other core topics of anesthesiology. Johannes Zipperle (AUVA Medical Directorate) was appointed as working group leader, and Gerhard Fritsch from Salzburg UKH was appointed for the clinical leadership of the group, which is dedicated to interdisciplinarity, innovation and the promotion of young researchers. Fritsch and Zipperle see the translational nature of their work as the most important principle of their research. I.e. that projects that have arisen from clinical questions are implemented at different levels of the scientific process (from basic research to preclinical and clinical research). Conversely, the group aims to maintain a constant interplay between the clinics and the laboratory. In this process, advanced solutions suitable for everyday use in the clinic are to be developed within the framework of scientific studies.

A wide range of research projects from laboratory studies to preclinical models to purely clinical studies provide the translational approach to scientific problem solving.

Focus areas within the group:

  1. Trauma-induced coagulopathy (TIC)
  2. Clinical questions and basic research in the field of regional anesthesia and pain medicine

Ongoing Projects:

  • “Influence of Regional Anesthesia on the Acute Compartment-Syndrome”
  • “Platelet function in major trauma”
  • “Influence of Severe Trauma on the Innate and Congenital Immune System”
  • “Point-of-care diagnostics and goal-directed therapy in bleeding management”
a. Fibrin molecules combine to form long fibrin threads that entangle blood cells.

Selected Publications

Hofer H, Oberladstätter D, Schlimp CJ, Voelckel W, Zipperle J, Lockie C, Grottke O, Osuchowski M, Schöchl H (2022) Role of DOAC plasma concentration on perioperative blood loss and transfusion requirements in patients with hip fractures. Eur J Trauma Emerg Surg. 2022 Jul 16. 

Katzensteiner M, Ponschab M, Schöchl H, Oberladstätter D, Zipperle J, Osuchowski M, Schlimp CJ (2022). Factor XIII Measurement and Substitution in Trauma Patients after Admission to an Intensive Care Unit. J Clin Med. 2022 Jul 19;11(14):4174. 
(free PDF)

Zipperle J, Ziegler B, Schöchl H, Voelckel W, Dungel P, Cadamuro J, Osuchowski M, Schlimp CJ, Oberladstätter D (2022). Conventional and Pro-Inflammatory Pathways of Fibrinolytic Activation in Non-Traumatic Hyperfibrinolysis. J Clin Med. 2022 Dec 9;11(24):7305. 
(free PDF)

Zipperle J, Ziegler B, Schöchl H, Voelckel W, Schlimp CJ, Oberladstätter D (2022) Operability of a Resonance-Based Viscoelastic Haemostatic Analyzer in the High-Vibration Environment of Air Medical Transport. J Clin Med. 2022 Jun 23;11(13):3630.
(free PDF)

Zipperle J, Oberladstätter D, Weichselbaum N, Schlimp CJ, Hofmann N, Iapichino G, Voelckel W, Ziegler B, Grottke O, Osuchowski MF, Schöchl H (2022) Thromboelastometry fails to detect autoheparinization after major trauma and hemorrhagic shock. J Trauma Acute Care Surg2022 Mar 1;92(3):535-541.

Oberladstätter D, Schlimp C, Zipperle J, Osuchowski MF, Voelckel W, Grottke O, Schöchl H (2021) Impact of Idarucizumab and Andexanet Alfa on DOAC Plasma Concentration and ClotPro ® Clotting Time: An Ex Vivo Spiking Study in A Cohort of Trauma Patients. J Clin Med. 2021 Aug 6;10(16):3476.
(free PDF)

Weichselbaum N, Oberladstätter D, Schlimp C, Zipperle J, Voelckel W, Grottke O, Zimmermann G, Osuchowski MF, Schöckl H (2021) High Interleukin-6 Plasma Concentration upon Admission Is Predictive of Massive Transfusion in Severely Injured Patients. J Clin Med2021 May 24;10(11):2268.
(free PDF)

Oberladstätter D, Voelckel W, Schlimp C, Zipperle J, Ziegler B, Grottke O, Schöchl H (2020) A prospective observational study of the rapid detection of clinically-relevant plasma direct oral anticoagulant levels following acute traumatic injury. Anaesthesia. 2020 Sep 18

Gratz J, Martin Ponschab M, Iapichino GE, Schlimp CJ, Cadamuro J, Grottke O, Zipperle J, Oberladstätter D, Gabriel C, Ziegler B, Schöchl H (2020) Comparison of fresh frozen plasma vs. coagulation factor concentrates for reconstitution of blood: An in vitro study. Eur J Anaesthesiol. 2020 Oct;37(10):879-888.

Ziegler B, Voelckel W, Zipperle J, Grottke O, Schöchl H (2019) Comparison between the new fully automated viscoelastic coagulation analysers TEG 6s and ROTEM Sigma in trauma patients: A prospective observational study. Eur J Anaesthesiol. 2019 Nov;36(11):834-842.

Hofmann N, Zipperle J, Brettner F, Jafarmadar M, Ashmwe M, Keibl C, Ponschab M, Kipman U, Bahrami A, Redl H, Bahrami S, Fuhrmann V, Schöchl H (2019). Effect of Coagulation Factor Concentrates on Markers of Endothelial Cell Damage in Experimental Hemorrhagic Shock. Shock 2019 Nov 29.

Zipperle J, Altenburger K, Ponschab M, Schlimp CJ, Spittler A, Bahrami S, Redl H, Schöchl H (2017). Potential role of platelet-leukocyte aggregation in trauma-induced coagulopathy: Ex vivo findings. J Trauma Acute Care Surg, 82(5):921-926.

Schöchl H, Grottke O, Sutor K, Dony K, Schreiber M, Ranucci M, Collins PW (2017). Theoretical Modeling of Coagulation Management With Therapeutic Plasma or Prothrombin Complex Concentrate. Anesth Analg, 125(5):1471-1474

Maegele M, Grottke O, Schöchl H, Sakowitz OA, Spannagl M & Koscielny J (2016). Direct Oral Anticoagulants in Emergency Trauma Admissions. Dtsch Arztebl Int, 113(35-36):575-582.
(free PDF)

Schlimp CJ, Ponschab M, Voelckel W, Treichl B, Maegele M & Schöchl H (2016). Fibrinogen levels in trauma patients during the first seven days after fibrinogen concentrate therapy: a retrospective study. Scand J Trauma Resusc Emerg Med, 24:29.
(free PDF)

Maegele M, Schöchl H & Cohen MJ (2014). An update on the coagulopathy of trauma. Shock, 41 Suppl 1:21-25.

Haas T, Fries D, Tanaka KA, Asmis L, Curry NS, Schöchl H (2014). Usefulness of standard plasma coagulation tests in the management of perioperative coagulopathic bleeding: is there any evidence? Br J Anaesth, 114(2):217-224.

Schöchl H & Schlimp CJ (2014). Trauma bleeding management: the concept of goal-directed primary care. Anesth Analg, 119(5):1064-1073.

Inaba K, Karamanos E, Lustenberger T, Schöchl H, Shulman I, Nelson J, Rhee P, Talving P, Lam L & Demetriades D (2013). Impact of fibrinogen levels on outcomes after acute injury in patients requiring a massive transfusion. J Am Coll Surg, 216(2):290-297.

Schöchl H, Voelckel W, Grassetto A & Schlimp CJ (2013). Practical application of point-of-care coagulation testing to guide treatment decisions in trauma. J Trauma Acute Care Surg, 74(6):1587-1598.

Schöchl H, Maegele M, Solomon C, Görlinger K & Voelckel W (2012). Early and individualized goal-directed therapy for trauma-induced coagulopathy. Scand J Trauma Resusc Emerg Med, 20:15.
(free PDF)

Cotton BA, Harvin JA, Kostousouv V, Minei KM, Radwan ZA, Schöchl H, Wade CE, Holcomb JB & Matijevic N (2012). Hyperfibrinolysis at admission is an uncommon but highly lethal event associated with shock and prehospital fluid administration. J Trauma Acute Care Surg, 73(2):365-370.

Görlinger K, Fries D, Dirkmann D, Weber CF, Hanke AA & Schöchl H (2012). Reduction of fresh frozen plasma requirements by perioperative point-of-care coagulation management with early calculated goal-directed therapy. Transfus Med Hemother, 39(2):104-113.
(free PDF)

Schöchl H, Nienaber U, Maegele M, Hochleitner G, Primavesi F, Steitz B, Arndt C, Hanke A, Voelckel W & Solomon C (2011). Transfusion in trauma: thromboelastometry-guided coagulation factor concentrate-based therapy versus standard fresh frozen plasma-based therapy. Crit Car, 15(2):R83.
(free PDF)

Schöchl H, Cotton B, Inaba K, Nienaber U, Fischer H, Voelckel W & Solomon C (2011). FIBTEM provides early prediction of massive transfusion in trauma. Crit Care, 15(6):R265.
(free PDF)

Solomon C, Traintinger S, Ziegler B, Hanke A, Rahe-Meyer N, Voelckel W & Schöchl H (2011). Platelet function following trauma: A multiple electrode aggregometry study. Thromb Haemost, 106(2):322-330.

Schöchl H, Nienaber U, Hofer G, Voelckel W, Jambor C, Scharbert G, Kozek-Langenecker S & Solomon C (2010). Goal-directed coagulation management of major trauma patients using thromboelastometry (ROTEM)-guided administration of fibrinogen concentrate and prothrombin complex concentrate. Crit Care, 14(2):R55.
(free PDF)

Solomon C, Pichlmaier U, Schoechl H, Hagl C, Raymondos K, Scheinichen D, Koppert W & Rahe-Meyer N (2010). Recovery of fibrinogen after administration of fibrinogen concentrate to patients with severe bleeding after cardiopulmonary bypass surgery. Br J Anaesth, 104(5):555-562.
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Schöchl H, Frietsch T, Pavelka M & Jámbor C (2009). Hyperfibrinolysis after major trauma: differential diagnosis of lysis patterns and prognostic value of thrombelastometry. J Trauma, 67(1):125-131.