Massive transfusion in trauma

Abstract

Purpose of review The purpose of this review is to provide an overview of currently recommended treatment approaches for traumatic hemorrhage shock, with a special focus on massive transfusion. Recent findings Severe trauma patients require massive transfusion, but consensual international definitions for traumatic hemorrhage shock and massive transfusion are missing. Current literature defines a massive transfusion as transfusion of a minimum of 3–4 packed red blood cells within 1 h. Using standard laboratory and/or viscoelastic tests, earliest diagnosis and treatment should focus on trauma-induced coagulopathy and substitution of substantiated deficiencies. Summary To initiate therapy immediately massive transfusion protocols are helpful focusing on early hemorrhage control using hemostatic dressing and tourniquets, correction of metabolic derangements to decrease coagulopathy and substitution according to viscoelastic assays and blood gases analysis with tranexamic acid, fibrinogen concentrate, red blood cells, plasma and platelets are recommended. Alternatively, the use of whole blood is possible. If needed, further support using prothrombin complex, factor XIII or desmopressin is suggested.

Blood Transfusion for Major Trauma in Emergency Department

“…The decision to start with a balanced ratio of plasma/platelets/red blood cells unit or a partial ratio of 1:2 (plasma/red blood cells) is based on subjective clinical criteria and the availability of blood products by the blood bank [76][77][78][79]. The right time of transport, the use of blood tests [71] have not been standardized yet in the trials available right now [70,80]. It is a common opinion that the immediate recognition of patients who can benefit from immediate transfusions of blood products is essential.…”