Massive transfusion and nonsurgical hemostatic agents

Perkins, Jeremy G.; Andrew, P.; Weiss, Brendan M.; Reid, Thomas J.; Bolan, Charles E.

doi:10.1097/ccm.0b013e31817e2ec5

Cited by 96 publications

(50 citation statements)

References 268 publications

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“…Protokoli za masivnu transfuziju su modifikovani, ali svi razmatraju izbor i odnos koncentrovanih eritrocita, plazme i trombocita. Nedavne studije su preporučile nadoknadu koncentrovanih eritrocita, sveže smrznute plazme i trombocita u odnosu 1:1:1 u cilju sprečavanja nastanka dilucione koagulopatije 11,12,13,14 . Međutim, savremena istraživanja poka-zuju da je perioperativni monitoring koagulacije jako važan u adekvatnom i pravovremenom sagledavanju koagulacionog sistema bolesnika.…”

Section: Diskusijaunclassified

The importance of the use of rotational thrombelastometry during intraoperative bleeding: Rotational elastometry and intraoperative bleeding

Stojanović¹,

Kojic²,

Knezevic³

et al. 2016

Serb J Anes Inten Therap

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Section: Diskusijaunclassified

The importance of the use of rotational thrombelastometry during intraoperative bleeding: Rotational elastometry and intraoperative bleeding

Stojanović¹,

Kojic²,

Knezevic³

et al. 2016

Serb J Anes Inten Therap

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“…3 As bleeding continues, platelets are consumed, thrombocytopenia develops, and other key factors such as fibrinogen become depleted, creating a complication known as dilutional coagulopathy. 19 In addition to these effects, increased fibrinolysis may occur, making the formation of stable clots impossible. When bleeding persists, adequate replacement of red blood cells, platelets, and coagulation factors becomes increasingly difficult.…”

Section: Blood Transfusion In Postoperative Hemorrhagementioning

confidence: 99%

“…Early administration of plasma (fresh frozen or prethawed) to prevent dilutional coagulopathy is recommended for patients who will receive multiple units of blood. 19 The coagulopathy that occurs after trauma to body tissues is associated with multiple variables, including those described previously, plus the amount of blood loss, and the patient's response to the injury and subsequent treatment. 18 Patients who receive multiple blood products are also at risk for hyperkalemia, hypocalcemia, and hypomagnesemia.…”

Section: Blood Transfusion In Postoperative Hemorrhagementioning

confidence: 99%

“…Hypothermia is prevented and treated by using heated blankets, warmed air systems, and warmed intravenous fluids and blood. 18,19 Coagulopathy can be magnified by the continuing need for and ongoing administration of transfusions. Administration of blood products and intravenous fluids dilutes the concentration of coagulation factors, making clot formation difficult.…”

Section: Blood Transfusion In Postoperative Hemorrhagementioning

confidence: 99%

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Coagulopathy in the Intensive Care Unit

Dressler

2012

Critical Care Nurse

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Coagulopathy is a potential problem for many critically ill patients, placing them at risk for hemorrhage. Critical illness activates both hemostasis and the inflammatory-immune system, leading to both physiological and potentially pathophysiological responses. Following complex surgery or trauma, patients are at high risk for development of problems such as thrombocytopenia and postoperative bleeding, challenging nurses to recognize and manage these problems. The clinical manifestations of coagulopathy may be obvious or occult, and correlation with the coagulation panel results is a complex process. Transfusion of blood and components has long been an important part of patient management, but is known to put patients at risk for transfusion-related complications. Current clinical practice guidelines provide blood conservation strategies and criteria to guide decisions on transfusion therapy.

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“…In addition, contractility of the heart and systemic vascular resistance are diminished under decreased ionized calcium levels. Because of its combined beneficial cardiovascular and coagulation effects, the calcium concentration should be monitored periodically with every ten units of transfusion, and it is recommended that a concentration of at least 0.9 mmol/L be maintained [64,65].…”

Section: Calciummentioning

confidence: 99%

Damage control resuscitation: a practical approach for severely hemorrhagic patients and its effects on trauma surgery

Mizobata

2017

j intensive care

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Coagulopathy observed in trauma patients was thought to be a resuscitation-associated phenomenon. The replacement of lost and consumed coagulation factors was the mainstay in the resuscitation of hemorrhagic shock for many decades. Twenty years ago, damage control surgery (DCS) was implemented to challenge the coagulopathy of trauma. It consists of three steps: abbreviated surgery to control the hemorrhage and contamination, resuscitation in the intensive care unit (ICU), and planned re-operation with definitive surgery. The resuscitation strategy of DCS focused on the rapid reversal of acidosis and prevention of hypothermia through the first two steps. However, direct treatment of coagulopathy was not emphasized in DCS. Recently, better understanding of the pathophysiology of coagulopathy in trauma patients has led to the logical opinion that we should directly address this coagulopathy during major trauma resuscitation. Damage control resuscitation (DCR), the strategic approach to the trauma patient who presents in extremis, consists of balanced resuscitation, hemostatic resuscitation, and prevention of acidosis, hypothermia, and hypocalcemia. In balanced resuscitation, fluid administration is restricted and hypotension is allowed until definitive hemostatic measures begin. The administration of blood products consisting of fresh frozen plasma, packed red blood cells, and platelets, the ratio of which resembles whole blood, is recommended early in the resuscitation. DCR strategy is now the most beneficial measure available to address trauma-induced coagulopathy, and it can change the treatment strategy of trauma patients. DCS is now incorporated as a component of DCR. DCR as a structured intervention begins immediately after rapid initial assessment in the emergency room and progresses through the operating theater into the ICU in combination with DCS. By starting from ground zero with the performance of DCS, DCR allows the trauma surgeon to correct the coagulopathy of trauma. The effect of the reversal of coagulopathy in massively hemorrhagic patients may change the operative strategy with DCS.

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Massive transfusion and nonsurgical hemostatic agents

Abstract: This review describes the clinical problems associated with massive transfusion and surveys the nonsurgical management of hemorrhage, including transfusion of blood products, use of hemostatic bandages/agents, and treatment with hemostatic medications.

Cited by 96 publications

References 268 publications

The importance of the use of rotational thrombelastometry during intraoperative bleeding: Rotational elastometry and intraoperative bleeding

The importance of the use of rotational thrombelastometry during intraoperative bleeding: Rotational elastometry and intraoperative bleeding

Coagulopathy in the Intensive Care Unit

Damage control resuscitation: a practical approach for severely hemorrhagic patients and its effects on trauma surgery

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