Testing of Blood Products in a Polytrauma Model: Results of a Multi-Institutional Randomized Preclinical Trial

Alam, Hasan B.; Bice, Leticia M.; Butt, Muhammad U.; Cho, S. David; Dubick, Michael A.; Duggan, Michael; Englehart, Michael S.; Holcomb, John B.; Morris, Melanie S.; Prince, M. Dale; Schreiber, Martin A.; Shults, Christian; Sondeen, Jill L.; Tabbara, Malek; Tieu, Brandon H.; Underwood, Samantha

doi:10.1097/ta.0b013e3181b5ae75

Cited by 55 publications

(39 citation statements)

References 24 publications

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“…2,39 Plasma is the treatment of choice to prevent or mitigate coagulopathy in trauma patients; even in the absence of transfused erythrocytes its use was shown in an animal model to be superior to a colloid at reversing the coagulopathy of trauma and to improve survival. 40 The availability of FLyP in austere settings, as well as in prehospital units, could benefit severe trauma patients, and its use could be extended to civilian centers. However, strong evidence is lacking regarding the wide use of FLyP in emergency settings, and clinical trials should be promoted to address the issue of a benefit of the use of FLyP instead of thawed FFP.…”

Section: Critical Care Medicinementioning

confidence: 99%

In Vitro Hemostatic Properties of French Lyophilized Plasma

Martinaud¹,

Civadier

Ausset³

et al. 2012

Anesthesiology

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Background: French lyophilized plasma (FLyP) is used routinely by the French Armed Forces in war settings. The authors compared concentrations of coagulation proteins and global in vitro hemostatic properties in FLyP and in the same plasma before lyophilization to assess the impact of lyophilization on coagulation properties. Methods: Twenty-four batches of plasma before and after lyophilization were tested for coagulation proteins. Thrombin generation time, thrombin antithrombin concentration, prothrombin fragment 1 ϩ 2, and thromboelastography were assessed. Finally, the efficiencies of FLyP and plasma before lyophilization were compared on a hemorrhagic shock hemodilution model and tested on TEG

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Section: Critical Care Medicinementioning

confidence: 99%

In Vitro Hemostatic Properties of French Lyophilized Plasma

Martinaud¹,

Civadier

Ausset³

et al. 2012

Anesthesiology

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“…Zaar et al 17 used liver damage in 30-kg pigs which caused a moderately large Alam et al 18 subjected pigs to femur fracture, controlled hemorrhage, and finally to liver damage. In this complex model resuscitation with 6% hetastarch (MW 600 kD, Hextend) resulted in 85% mortality while fresh whole blood, fresh frozen plasma with and without red blood cells in the ratio 1:1 were followed by 100% survival.…”

Section: Starchmentioning

confidence: 99%

Fluid therapy in uncontrolled hemorrhage – what experimental models have taught us

Hahn

2012

Acta Anaesthesiol Scand

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Intravenous fluid is life-saving in hypovolemic shock, but fluid sometimes aggravates the bleeding. During the past 25 years, animal models have helped our understanding of the mechanisms involved in this unexpected effect. A key issue is that vasoconstriction is insufficient to arrest the bleeding when damage is made to a major blood vessel. ‘Uncontrolled hemorrhage’ is rather stopped by a blood clot formed at the outside surface of the vessel, and the immature clot is sensitive to mechanical and chemical interactions. The mortality increases if rebleeding occurs. In the aortic tear model in swine, hemorrhage volume and the mortality increase from effective restoration of the arterial pressure. The mortality vs. amount of fluid curve is U-shaped with higher mortality at either end. Without any fluid at all, irreversible shock causes death provided the hemorrhage is sufficiently large. Crystalloid fluid administered in a 3 : 1 proportion to the amount of lost blood initiates serious rebleeding. Hypertonic saline 7.5% in 6% dextran 70 (HSD) also provokes rebleeding resulting in higher mortality in the recommended dosage of 4 ml/kg. Uncontrolled hemorrhage models in rats, except for the ‘cut-tail’ model, confirm the results from swine. To avoid rebleeding, fluid programs should not aim to fully restore the arterial pressure, blood flow rates, or blood volume. For a hemorrhage of 1000 ml, computer simulations show that deliberate hypovolemia (−300 ml) would be achieved by infusing 600–750 ml crystalloid fluid over 20–30 min or 100 ml of HSD over 10–20 min in an adult male

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“…A recent process improvement project that was conducted in theater among evacuation units in Afghanistan showed that nearly all casualties transported received a routine infusion of crystalloids and that less than 10% of those with significant hemorrhage received the appropriate fluid therapy in accordance with tactical combat casualty care (TCCC) guidelines. 26 According to Alam et al, 27 infusion of large amount of crystalloids can result in significant lactic acidosis, dilutional anemia, and thrombocytopenia. Also according to Alam et al, 27 large doses of hetastarch fluid in trauma patients could result in worsening coagulopathy.…”

Section: Discussionmentioning

confidence: 99%

“…26 According to Alam et al, 27 infusion of large amount of crystalloids can result in significant lactic acidosis, dilutional anemia, and thrombocytopenia. Also according to Alam et al, 27 large doses of hetastarch fluid in trauma patients could result in worsening coagulopathy. Another reason for a discrepancy in the fluid management is that the CCFP group not only had formalized certification, didactics, and hands-on training, but also had 9 years of trauma experience.…”

Section: Discussionmentioning

confidence: 99%