Improved Survival Following Massive Transfusion in Patients Who Have Undergone Trauma

Cinat, Marianne

doi:10.1001/archsurg.134.9.964

Cited by 201 publications

(122 citation statements)

References 22 publications

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“…37 Recent studies suggest that fibrinogen administration is essential for achieving hemostasis in patients with significant traumatic injuries [43][44][45][46][47][48] and very likely contributes to the improved outcomes that have been associated with increased transfusion of plasma. 7,49,50 However, the use of plasma as a volume expander is controversial though this practice has been relatively abandoned since the 1940s. 33 Volume expansion for hypovolemic patients in hemorrhagic shock is required to improve cardiac output by maintaining preload.…”

Section: Discussionmentioning

confidence: 99%

Effect of Plasma and Red Blood Cell Transfusions on Survival in Patients With Combat Related Traumatic Injuries

Spinella

Perkins

Grathwohl

et al. 2008

Journal of Trauma: Injury, Infection &Amp; Critical Care

159

108

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Section: Discussionmentioning

confidence: 99%

Effect of Plasma and Red Blood Cell Transfusions on Survival in Patients With Combat Related Traumatic Injuries

Spinella

Perkins

Grathwohl

et al. 2008

Journal of Trauma: Injury, Infection &Amp; Critical Care

159

108

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“…6 Interestingly, 2 studies by Cinat and Cosgriff in the late 1990s described similar ratios, but did not garner the attention that the combat trauma paper received. 31,32 After the Borgman publication, many other groups published similar data from single and multicenter retrospective studies from around the world. Most associated earlier and higher ratios of plasma and platelet use with improved outcomes.…”

mentioning

confidence: 99%

Optimal trauma resuscitation with plasma as the primary resuscitative fluid: the surgeon's perspective

Holcomb¹,

2013

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Over the past century, blood banking and transfusion practices have moved from whole blood therapy to components. In trauma patients, the shift to component therapy was achieved without clinically validating which patients needed which blood products. Over the past 4 decades, this lack of clinical validation has led to uncertainty on how to optimally use blood products and has likely resulted in both overuse and underuse in injured patients. However, recent data from both US military operations and civilian trauma centers have shown a survival advantage with a balanced transfusion ratio of RBCs, plasma, and platelets. This has been extended to include the prehospital arena, where thawed plasma, RBCs, and antifibrinolytics are becoming more widely used. The Texas Trauma Institute in Houston has followed this progression by putting RBCs and thawed plasma in the emergency department and liquid plasma and RBCs on helicopters, transfusing platelets earlier, and using thromboelastogram-guided approaches. These changes have not only resulted in improved outcomes, but have also decreased inflammatory complications, operations, and overall use of blood products. In addition, studies have shown that resuscitating with plasma (instead of crystalloid) repairs the "endotheliopathy of trauma," or the systemic endothelial injury and dysfunction that lead to coagulation disturbances and inflammation. Data from the Trauma Outcomes Group, the Prospective Observational Multicenter Major Trauma Transfusion (PROMMTT) study, and the ongoing Pragmatic Randomized Optimal Platelet and Plasma Ratios (PROPPR) trial represent a decade-long effort to programmatically determine optimal resuscitation practices, balancing risk versus benefits. With injury as the leading cause of death in patients age 1 to 44 years and hemorrhage the leading cause of potentially preventable death in this group, high-quality data must be obtained to provide superior care to the civilian and combat injured.

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“…In the United States alone, over 15 million units are transfused annually (159). These transfusions are often life saving (27,29,106,154) and rarely cause serious adverse events, although side effects do occur (23,37,70,71,82,105). However, most U.S. hospitals consistently report blood shortages (159), and studies predict that these shortages will worsen as the population ages (53,130,144,164).…”

mentioning

confidence: 99%

Development of Recombinant Hemoglobin-Based Oxygen Carriers

Varnado

Mollan

Birukou

et al. 2013

Antioxidants & Redox Signaling

102

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Significance: The worldwide blood shortage has generated a significant demand for alternatives to whole blood and packed red blood cells for use in transfusion therapy. One such alternative involves the use of acellular recombinant hemoglobin (Hb) as an oxygen carrier. Recent Advances: Large amounts of recombinant human Hb can be expressed and purified from transgenic Escherichia coli. The physiological suitability of this material can be enhanced using protein-engineering strategies to address specific efficacy and toxicity issues. Mutagenesis of Hb can (i) adjust dioxygen affinity over a 100-fold range, (ii) reduce nitric oxide (NO) scavenging over 30-fold without compromising dioxygen binding, (iii) slow the rate of autooxidation, (iv) slow the rate of hemin loss, (v) impede subunit dissociation, and (vi) diminish irreversible subunit denaturation. Recombinant Hb production is potentially unlimited and readily subjected to current good manufacturing practices, but may be restricted by cost. Acellular Hb-based O 2 carriers have superior shelf-life compared to red blood cells, are universally compatible, and provide an alternative for patients for whom no other alternative blood products are available or acceptable. Critical Issues: Remaining objectives include increasing Hb stability, mitigating iron-catalyzed and iron-centered oxidative reactivity, lowering the rate of hemin loss, and lowering the costs of expression and purification. Although many mutations and chemical modifications have been proposed to address these issues, the precise ensemble of mutations has not yet been identified. Future Directions: Future studies are aimed at selecting various combinations of mutations that can reduce NO scavenging, autooxidation, oxidative degradation, and denaturation without compromising O 2 delivery, and then investigating their suitability and safety in vivo. Antioxid. Redox Signal. 18, 2314-2328.

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Improved Survival Following Massive Transfusion in Patients Who Have Undergone Trauma

Cited by 201 publications

References 22 publications

Effect of Plasma and Red Blood Cell Transfusions on Survival in Patients With Combat Related Traumatic Injuries

Effect of Plasma and Red Blood Cell Transfusions on Survival in Patients With Combat Related Traumatic Injuries

Optimal trauma resuscitation with plasma as the primary resuscitative fluid: the surgeon's perspective

Development of Recombinant Hemoglobin-Based Oxygen Carriers

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