Advances in hemorrhage control resuscitation

Abstract

Purpose of reviewDespite significant advances in trauma management over the last twenty years, uncontrolled hemorrhage remains the leading cause of preventable death in trauma. We review recent changes affecting hemorrhage control resuscitation.Recent findingsEarly blood product usage has become well established as a standard of care in trauma hemorrhage control. To enable this, low titer group A liquid plasma and group O whole blood are increasingly utilized. Single donor apheresis platelets have now replaced pooled donor platelets in the USA and are often pathogen reduced, which has implications for trauma resuscitation. Further work is examining timing and dosing of tranexamic acid and the debate in factor concentrate usage in trauma induced coagulopathy continues to evolve. The ‘Stop the bleed’ campaign has highlighted how important the use of hemostatic dressings are in hemorrhage control, as too is the expanded use of endovascular aortic occlusion. We highlight the ongoing research into desmopressin use and the undetermined significance of ionized calcium levels in trauma. Finally, we discuss our own hospital experience with coagulation testing and the paucity of evidence of improved outcomes with viscoelastic testing.SummaryImproving trauma coagulopathy diagnostics and hemorrhage control are vital if we are to decrease the mortality associated with trauma.

Trauma-Induced Coagulopathy: What You Need to Know

“…56 Hemorrhage control should be early and aggressive and may include measures such as tourniquets, direct pressure, hemostatic dressings, and retrograde endovascular balloon occlusion of the aorta. 62 Regarding blood and component transfusions, damage-control resuscitation with a massive transfusion protocol in a 1:1:1 ratio of RBCs, plasma, and platelets-or whole blood, if available-remains the criterion standard treatment. 47,63,64 Early administration of TXA (within 1 hour of injury) is also recommended to reduce exsanguination and to reduce mortality.…”

“…The mainstays of treatment include hemorrhage control, blood and component transfusions, and correction of abnormalities such as hypocalcemia, acidosis, and hypothermia 56 . Hemorrhage control should be early and aggressive and may include measures such as tourniquets, direct pressure, hemostatic dressings, and retrograde endovascular balloon occlusion of the aorta 62 . Regarding blood and component transfusions, damage-control resuscitation with a massive transfusion protocol in a 1:1:1 ratio of RBCs, plasma, and platelets—or whole blood, if available—remains the criterion standard treatment 47,63,64 .…”

Advances in the Management of Coagulopathy in Trauma: The Role of Viscoelastic Hemostatic Assays across All Phases of Trauma Care

“…However, bleeding can be controlled temporarily in the field with direct pressure, packing, and placement of pelvic binders and tourniquets, as well as in the ED with other advanced maneuvers, including resuscitative endovascular balloon occlusion of the aorta. [33][34][35][36][37] The goal is to transfer the patient to the OR, interventional suite, or hybrid OR for definitive hemorrhage control. [38][39][40][41] Resuscitation strategies for bleeding patients have changed dramatically over the last several decades with an emphasis on early transfusion of balanced ratios of packed red blood cells, plasma, and platelets, or whole blood (where available), and avoidance of crystalloids.…”

“…However, bleeding can be controlled temporarily in the field with direct pressure, packing, and placement of pelvic binders and tourniquets, as well as in the ED with other advanced maneuvers, including resuscitative endovascular balloon occlusion of the aorta. 33 34 35 36 37 The goal is to transfer the patient to the OR, interventional suite, or hybrid OR for definitive hemorrhage control. 38 39 40 41…”

Influence of hypocalcemia on the prognosis of patients with multiple trauma

“…With the rapid acceleration of human social development, urban construction, and the rapid rise in car ownership, the number of traumas has increased dramatically[ 1 ]. Patients with trauma are often multi-injured, and the condition of multi-injury is more complex and critical, with a poor prognosis and a high risk of death.…”