Hemostatic Resuscitation

Andrew, P.; Gurney, Jennifer M; Meledeo, Michael Adam

doi:10.1007/978-3-030-20820-2_7

Cited by 8 publications

(17 citation statements)

References 128 publications

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“…16 Blood product administration as near to the time of injury as possible is currently recommended by the US Department of Defense Joint Trauma System Clinical Practice Guidelines for massively hemorrhaging, severely injured casualties, and those receiving prolonged field care. 4,17 However, the studies on which these guidelines rely were not randomized and differ widely in study design and execution.…”

Section: Military and Early Civilian Datamentioning

confidence: 99%

“…Transfusion therapy close to the time of injury is intended to prevent or reverse acute traumatic coagulopathy, restore oxygen carrying capacity, and minimize crystalloid administration. 3,4 Recently, the concept of prehospital transfusion (PHT) has been introduced into civilian trauma and was received with great enthusiasm. 5 Because of the unmet medical need to improve care of traumatic hemorrhage, some jurisdictions have adopted PHT strategies, which were supported largely by retrospective and observational data.…”

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confidence: 99%

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Pro-Con Debate: Prehospital Blood Transfusion—Should It Be Adopted for Civilian Trauma?

Dudaryk

Heim

Ruetzler

et al. 2022

Anesthesia &Amp; Analgesia

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Exsanguination is the leading cause of death in severely injured patients; nevertheless, prehospital blood transfusion (PHT) remains a controversial topic. Here, we review the pros and cons of PHT, which is now routine in treatment of military trauma patients in the civilian setting. While PHT may improve survival in those who suffer blunt injury or require prolonged transport from the site of injury, PHT for civilian trauma generally is not supported by high-quality evidence. This article was originally presented as a pro-con debate at the 2020 meeting of the European

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Section: Military and Early Civilian Datamentioning

confidence: 99%

mentioning

confidence: 99%

Pro-Con Debate: Prehospital Blood Transfusion—Should It Be Adopted for Civilian Trauma?

Dudaryk

Heim

Ruetzler

et al. 2022

Anesthesia &Amp; Analgesia

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“…However, iCa monitoring and hypocalcemia correction are recommended by numerous guidelines and review articles. 10,15,20 The most commonly used cutoff for calcium replacement is 0.9 to 1 mmol/L. 8 This study was designed to explore the incidence of EH in severe pediatric trauma and potential associated candidate outcomes suggested by studies in adult patients.…”

Section: Discussionmentioning

confidence: 99%

“…The median age was 11 years (interquartile range [IQR], 4-15), and 78.4% (87) were male. The median ISS was 21 (IQR, 17-27).Hypocalcemia was found in 19.8% ( 22) and severe hypocalcemia in 2.7% (3) of the patients.Although not statistically significant, hypocalcemic pediatric trauma patients had higher ISS (25.5 [IQR,(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29) vs 21 [IQR,[17][18][19][20][21][22][23][24][25][26], P = 0.39), lower Glasgow Coma Scale (11 [IQR,[3][4][5][6][7][8][9][10][11][12][13][14][15] vs 13 [IQR, 7-15], P = 0.24), a more prolonged hospital stay (8 days [IQR, 2-16] vs 6 days [IQR, 3-13], P = 0.36), a more frequent need for blood products (27.3% vs 20.2%, P = 0.74), and higher mortality rates (9.1% vs 1.1%, P = 0.18) compared with normocalcemic patients.…”

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confidence: 83%

Early Hypocalcemia in Pediatric Major Trauma

et al. 2022

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ObjectiveEarly hypocalcemia (EH) is common in adult major trauma patients and has been associated with coagulopathy, shock, increased transfusion requirements, and mortality. The incidence of EH in pediatric severe trauma has not been investigated. We aimed to explore the incidence of EH among severely injured children.MethodsWe conducted a retrospective cohort study at a tertiary children's hospital and a level 1 pediatric trauma center. We extracted the medical records of all pediatric major trauma patients, defined as an age less than 18 years and an Injury Severity Score (ISS) greater than 15, admitted after trauma team activation from January 2010 to December 2020.The primary outcome was the presence of EH. Patients were classified into 3 groups: severe hypocalcemia (ionized calcium [iCa] <1 mmol/L), hypocalcemia (1 < iCa < 1.16 mmol/L), and normal calcium (iCa ≥1.16 mmol/L).ResultsDuring the study period, 5126 children were hospitalized because of trauma. One hundred eleven children met the inclusion criteria. The median age was 11 years (interquartile range [IQR], 4–15), and 78.4% (87) were male. The median ISS was 21 (IQR, 17–27).Hypocalcemia was found in 19.8% (22) and severe hypocalcemia in 2.7% (3) of the patients.Although not statistically significant, hypocalcemic pediatric trauma patients had higher ISS (25.5 [IQR, 17–29] vs 21 [IQR, 17–26], P = 0.39), lower Glasgow Coma Scale (11 [IQR, 3–15] vs 13 [IQR, 7–15], P = 0.24), a more prolonged hospital stay (8 days [IQR, 2–16] vs 6 days [IQR, 3–13], P = 0.36), a more frequent need for blood products (27.3% vs 20.2%, P = 0.74), and higher mortality rates (9.1% vs 1.1%, P = 0.18) compared with normocalcemic patients.ConclusionsOur data suggest that in the setting of major trauma, EH is less frequent in children than previously reported in adults. Our preliminary data suggest that pediatric patients with EH may be at risk of increased morbidity and mortality compared with children with normal admission iCa requiring further studies.

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“…These documents prioritized the use of whole blood as the preferred resuscitative fluid for patients that meet the described criteria for blood transfusion, elevating it above component therapy while encouraging the use of FDA-approved products to the greatest extent possible. [6][7][8] The pace of change in medical practice and health care policy is often measured in years, however, there were significant efforts through a collaboration between the combatant command, the Joint Trauma System, and the Armed Services Blood Program to implement the clinical practice guideline recommendations in military expeditionary settings. 9,10 The purpose of this study is to evaluate the transition of transfusion practice during the period from 2017 to 2021 in USCENTCOM.…”

Section: Introductionmentioning

confidence: 99%

Whole blood administration within USCENTCOM

Hall¹,

Qureshi²,

Wilson

et al. 2023

Trauma

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Introduction Blood product use by the U.S. military has evolved during the conflicts in the U.S. Central Command's area of responsibility to become the preferred resuscitative fluid for damage control procedures. This study evaluates the transition to a whole blood-based trauma system over the past 5 years. Methods Patients who received blood product transfusion within USCENTCOM between January 1, 2017, and December 31, 2021, were identified from the Medical Situational Awareness in Theater (MSAT) blood reports. Transfusion recipients were categorized as recipients of whole blood only, component therapy only, or mixed therapy. The type of transfusions, number of recipients, number of available blood products were compared over the 5-year period. Results A total of 1762 unique patients were included. Of this population, 220 (12.5%) received whole blood only, 1196 (68.9%) received component therapy, and 346 (19.6%) received mixed therapy. The monthly proportion of individuals receiving whole blood (only or mixed) significantly increased over the 5-year period ( p < .0001). The number of individuals requiring transfusions over this same period decreased significantly ( p < .0001). Individuals receiving component therapy (only or mixed) were transfused component platelets 15.7% of the time. The mean and median number of units required per patient receiving whole blood was 2.39 and 1 unit of blood respectively (IQR 1.0–2.5). Conclusion Whole blood use increased significantly within USCENTCOM's AOR secondary to increased supply and low clinical requirement. Without a long-lasting platelet component, component therapy cannot be expected to provide a balanced therapy to casualties in remote locations.

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Hemostatic Resuscitation

Cited by 8 publications

References 128 publications

Pro-Con Debate: Prehospital Blood Transfusion—Should It Be Adopted for Civilian Trauma?

Pro-Con Debate: Prehospital Blood Transfusion—Should It Be Adopted for Civilian Trauma?

Early Hypocalcemia in Pediatric Major Trauma

Whole blood administration within USCENTCOM

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