A Decade of Damage Control Resuscitation

Cole, Elaine; Weaver, Anne; Gall, Lewis; West, Anita; Nevin, Daniel; Tallach, Rosel; O'Neill, Breda; Lahiri, Sumitra; Allard, Shubha; Tai, Nigel; Davenport, Ross; Green, Laura; Brohi, Karim

doi:10.1097/sla.0000000000003657

Cited by 103 publications

(60 citation statements)

References 37 publications

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“…In post-trauma patients, aggressive resuscitation, as previously recommended, with crystalloid dilutes clotting factors and causes metabolic acidosis (hyperchloremic in the case of 0.9% NaCl administration) and interstitial edema. This also caused by microcirculation impairment and impaired oxygen tissue supply [46][47][48]. Colloids cause proteins to move from the blood to the interstitial space, therefore reducing plasma concentration of clotting factors, in particular of factor VII and von Willebrand factor, inhibiting platelet function, and reducing the interaction between factor XIII and fibrin polymers.…”

Section: Coagulopathy Associated With Resuscitation Maneuversmentioning

confidence: 99%

Trauma-Induced Coagulopathy: Overview of an Emerging Medical Problem from Pathophysiology to Outcomes

et al. 2021

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Coagulopathy induced by major trauma is common, affecting approximately one-third of patients after trauma. It develops independently of iatrogenic, hypothermic, and dilutive causes (such as iatrogenic cause in case of fluid administration), which instead have a pejorative aspect on coagulopathy. Notwithstanding the continuous research conducted over the past decade on Trauma-Induced Coagulopathy (TIC), it remains a life-threatening condition with a significant impact on trauma mortality. We reviewed the current evidence regarding TIC diagnosis and pathophysiological mechanisms and summarized the different iterations of optimal TIC management strategies among which product resuscitation, potential drug administrations, and hemostatis-focused approaches. We have identified areas of ongoing investigation and controversy in TIC management.

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Section: Coagulopathy Associated With Resuscitation Maneuversmentioning

confidence: 99%

Trauma-Induced Coagulopathy: Overview of an Emerging Medical Problem from Pathophysiology to Outcomes

et al. 2021

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“…Severe bleeding in patients with trauma remains a challenge . Use of tranexamic acid (TXA), reduction of fluid expansion, high-ratio blood product transfusion, and expedient hemorrhage control have improved some patient outcomes, but mortality among patients with trauma and bleeding remains high due in part to trauma-induced coagulopathy . Trials of fixed ratio-based blood product transfusion, viscoelastic testing (VET) to guide a tailored combination of blood products, and a hybrid of the 2 approaches have provided a management evidence base for the trauma community, but no strategy has proven superior to another.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and Safety of Early Administration of 4-Factor Prothrombin Complex Concentrate in Patients With Trauma at Risk of Massive Transfusion

Bouzat

Charbit

Abback

et al. 2023

JAMA

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ImportanceOptimal transfusion strategies in traumatic hemorrhage are unknown. Reports suggest a beneficial effect of 4-factor prothrombin complex concentrate (4F-PCC) on blood product consumption.ObjectiveTo investigate the efficacy and safety of 4F-PCC administration in patients at risk of massive transfusion.Design, Setting, and ParticipantsDouble-blind, randomized, placebo-controlled superiority trial in 12 French designated level I trauma centers from December 29, 2017, to August 31, 2021, involving consecutive patients with trauma at risk of massive transfusion. Follow-up was completed on August 31, 2021.InterventionsIntravenous administration of 1 mL/kg of 4F-PCC (25 IU of factor IX/kg) vs 1 mL/kg of saline solution (placebo). Patients, investigators, and data analysts were blinded to treatment assignment. All patients received early ratio-based transfusion (packed red blood cells:fresh frozen plasma ratio of 1:1 to 2:1) and were treated according to European traumatic hemorrhage guidelines.Main Outcomes and MeasuresThe primary outcome was 24-hour all blood product consumption (efficacy); arterial or venous thromboembolic events were a secondary outcome (safety).ResultsOf 4313 patients with the highest trauma level activation, 350 were eligible for emergency inclusion, 327 were randomized, and 324 were analyzed (164 in the 4F-PCC group and 160 in the placebo group). The median (IQR) age of participants was 39 (27-56) years, Injury Severity Score was 36 (26-50 [major trauma]), and admission blood lactate level was 4.6 (2.8-7.4) mmol/L; prehospital arterial systolic blood pressure was less than 90 mm Hg in 179 of 324 patients (59%), 233 patients (73%) were men, and 226 (69%) required expedient hemorrhage control. There was no statistically or clinically significant between-group difference in median (IQR) total 24-hour blood product consumption (12 [5-19] U in the 4F-PCC group vs 11 [6-19] U in the placebo group; absolute difference, 0.2 U [95% CI, −2.99 to 3.33]; P = .72). In the 4F-PCC group, 56 patients (35%) presented with at least 1 thromboembolic event vs 37 patients (24%) in the placebo group (absolute difference, 11% [95% CI, 1%-21%]; relative risk, 1.48 [95% CI, 1.04-2.10]; P = .03).Conclusions and RelevanceAmong patients with trauma at risk of massive transfusion, there was no significant reduction of 24-hour blood product consumption after administration of 4F-PCC, but thromboembolic events were more common. These findings do not support systematic use of 4F-PCC in patients at risk of massive transfusion.Trial RegistrationClinicalTrials.gov Identifier: NCT03218722

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“…Hemorrhage is the leading cause of preventable death in civilian and battlefield traumatic injuries. 1,2 It has been reported that 60% of combat casualties resulted from massive bleeding and lack of effective treatment. In civilian traumatic injuries, massive bleeding is also the leading cause of death among people between 18 and 39, causing nearly 2 million deaths each year.…”

Section: Introductionmentioning

confidence: 99%

A point-of-care microfluidic channel-based device for rapid and direct detection of fibrinogen in whole blood

Ban¹,

Li²,

Cao³

et al. 2022

Lab Chip

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A Decade of Damage Control Resuscitation

Abstract: Supplemental Digital Content is available in the text

Cited by 103 publications

References 37 publications

Trauma-Induced Coagulopathy: Overview of an Emerging Medical Problem from Pathophysiology to Outcomes

Trauma-Induced Coagulopathy: Overview of an Emerging Medical Problem from Pathophysiology to Outcomes

Efficacy and Safety of Early Administration of 4-Factor Prothrombin Complex Concentrate in Patients With Trauma at Risk of Massive Transfusion

A point-of-care microfluidic channel-based device for rapid and direct detection of fibrinogen in whole blood

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