Early Predictors of Massive Transfusion in Combat Casualties

Schreiber, Martin A.; Perkins, Jeremy G.; Király, László; Underwood, Samantha; Wade, Charles E.; Holcomb, John B.

doi:10.1016/j.jamcollsurg.2007.05.007

Cited by 226 publications

(135 citation statements)

References 23 publications

Supporting

Mentioning

126

Contrasting

Unclassified

Order By: Relevance

“…Algorithms based on these scores shift clinical management from a reactive to a proactive stance [66][67][68][69][70][71]. Unfortunately, none of these scoring systems identify all patients at risk of ATC and death due to bleeding.…”

Section: Predicting Coagulopathymentioning

confidence: 99%

The pathogenesis of traumatic coagulopathy

2014

View full text Add to dashboard Cite

SummaryOver the last 10 years, the management of major haemorrhage in trauma patients has changed radically. This is mainly due to the recognition that many patients who are bleeding when they come in to the emergency department have an established coagulopathy before the haemodilution effects of fluid resuscitation. This has led to the use of new terminology: acute traumatic coagulopathy, acute coagulopathy of trauma shock or trauma‐induced coagulopathy. The recognition of acute traumatic coagulopathy is important, because we now understand that its presence is a prognostic indicator, as it is associated with poor clinical outcome. This has driven a change in clinical management, so that the previous approach of maintaining an adequate circulating volume and oxygen carrying capacity before, as a secondary event, dealing with coagulopathy, has changed to haemostatic resuscitation as early as possible. While there is as yet no universally accepted assay or definition, many experts use prolongation of the prothrombin time to indicate that there is, indeed, a coagulopathy. Hypoxia, acidosis and hypothermia and hormonal, immunological and cytokine production, alongside consumption and blood loss, and the dilutional effects of resuscitation may occur to varying extents depending on the type of tissue damaged, the type and extent of injury, predisposing to, or amplifying, activation of coagulation, platelets, fibrinolysis. These are discussed in detail within the article.

show abstract

Section: Predicting Coagulopathymentioning

confidence: 99%

The pathogenesis of traumatic coagulopathy

2014

View full text Add to dashboard Cite

show abstract

“…Although there appears to be a clear reduction in mortality for injured soldiers, 10,[13][14][15]41 this finding has recently been questioned within the civilian cohort. 1,[21][22][23][24] Prior to the implementation of a formalized high plasma MTP (Table 1), mortality for patients who required a massive transfusion (≥ 10 units of RBCs) following grade 3, 4 or 5 hepatic injuries at our institution was 60%, 46% and 71%, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] While the effect on overall mortality in the civilian population is still debated, [21][22][23][24] massive resuscitations with high plasma:packed red blood cell (RBC) ratios remain promising for addressing the early coagulopathy 25 and acidosis frequently associated with life-threatening injury. 10 Additional benefits of a formal MTP include earlier administration of blood products during the resuscitation phase, improved overall efficiency, decreased total blood product use during a patient's hospital stay and a substantial economic savings.…”

mentioning

confidence: 99%

The impact of a massive transfusion protocol (1:1:1) on major hepatic injuries: Does it increase abdominal wall closure rates?

et al. 2013

View full text Add to dashboard Cite

Background: Massive transfusion protocols (MTPs) using high plasma and platelet ratios for exsanguinating trauma patients are increasingly popular. Major liver injuries often require massive resuscitations and immediate hemorrhage control. Current published literature describes outcomes among patients with mixed patterns of injury. We sought to identify the effects of an MTP on patients with major liver trauma.Methods: Patients with grade 3, 4 or 5 liver injuries who required a massive blood component transfusion were analyzed. We compared patients with high plasma:red blood cell:platelet ratio (1:1:1) transfusions (2007)(2008)(2009)) with patients injured before the creation of an institutional MTP (2005MTP ( -2007.Results: Among 60 patients with major hepatic injuries, 35 (58%) underwent resuscitation after the implementation of an MTP. Patient and injury characteristics were similar between cohorts. Implementation of the MTP significantly improved plasma: red blood cell:platelet ratios and decreased crystalloid fluid resuscitation (p = 0.026). Rapid improvement in early acidosis and coagulopathy was superior with an MTP (p = 0.009). More patients in the MTP group also underwent primary abdominal fascial closure during their hospital stay (p = 0.021). This was most evident with grade 4 injuries (89% vs. 14%). The mean time to fascial closure was 4.2 days. The overall survival rate for all major liver injuries was not affected by an MTP (p = 0.61). Conclusion:The implementation of a formal MTP using high plasma and platelet ratios resulted in a substantial increase in abdominal wall approximation. This occurred concurrently to a decrease in the delivered volume of crystalloid fluid.Contexte : Les protocoles de transfusion massive (PTM) impliquant des rapports plasma:plaquettes élevés sont de plus en plus populaires pour traiter les patients atteints d'un traumatisme hémorragique. Les chirurgies majeures du foie requièrent souvent le déclenchement de protocoles de transfusion massive et une maîtrise immé-diate de l'hémorragie. La littérature actuelle décrit les résultats chez des patients victimes de divers types de traumatismes. Nous avons voulu mesurer les effets d'un PTM sur les patients ayant subi un traumatisme majeur au foie. Résultats : Sur 50 patients ayant subi des lésions hépatiques majeures, 35 (58 %) ont reçu des traitements de réanimation après la mise en place du PTM. Les caractéristiques propres aux patients et à leurs blessures étaient similaires entre les cohortes. L'application du PTM a significativement amélioré les rapports plasma:culots globulaires:plaquettes et réduit l'administration de cristalloïdes à des fins de réanimation liquidienne (p = 0,026). L'amélioration rapide de l'acidose naissante et de la coagulopathie a été meilleure avec le PTM (p = 0,009). Plus de patients du groupe soumis au PTM ont aussi subi une fermeture aponévrotique abdominale primaire durant leur séjour hospitalier (p = 0,021). Cela s'est surtout observé avec les lésions de grade 4 (89 % c. 14 %). Le délai moyen av...

show abstract

“…However, due to the coagulation disorders, hypothermia, acidosis and additional complications associated with blood transfusion, the clinical mortality rate remains high. MT in trauma patients affects a small percentage of civilian and military trauma patients, a great number of whom is expected to succumb to the disease early in their course from hemorrhage and to consume a great deal of trauma center resources (13,(17)(18)(19)(20)(21)(22)(23)(24). In their study, Riskin et al (25) suggested that implementation of a MT protocol and fixed blood component ratio are associated with reduced mortality.…”

Section: Discussionmentioning

confidence: 99%

Fixed rate of blood component improves the survival rate of patients in massive transfusion

Wang

Zhan

et al. 2012

Biomedical Reports

View full text Add to dashboard Cite

Abstract. The aim of this study was to examine the manner in which varying proportions of serum and red blood cells (RBC) in massive blood transfusion affect the survival rates of patients with severe blood loss. Massive transfusion (MT) was determined as receiving ≥10 units of red blood cells in 24 h. The electronic medical records and blood transfusion information for the period January, 2002 to December, 2011 of patients with MT were examined. Moreover, we calculated the ratio of blood components and examined their correlation with survival. In total, 1,658 patients underwent MT during the period 2002-2011, with an overall of 28,030 units RBC, accounting for 2.8% of the total blood transfusion. In conclusion, fixing blood-component ratios has the potential to help improve survival rate in MT.

show abstract

Early Predictors of Massive Transfusion in Combat Casualties

Cited by 226 publications

References 23 publications

The pathogenesis of traumatic coagulopathy

The pathogenesis of traumatic coagulopathy

The impact of a massive transfusion protocol (1:1:1) on major hepatic injuries: Does it increase abdominal wall closure rates?

Fixed rate of blood component improves the survival rate of patients in massive transfusion

Contact Info

Product

Resources

About