The Effect of Recombinant Activated Factor VII on Mortality in Combat-Related Casualties With Severe Trauma and Massive Transfusion

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

“…12,17,20,23,24 More importantly in animal and human studies of patients in shock, microvascular perfusion and oxygen consumption remains the same or decreases with RBC transfusion. 8,17,[25][26][27]59 The importance of the effect of RBC storage age on outcomes in critically ill patients is highlighted by the fact that the average age of transfused RBCs in the United States is 22 days 60 and multiple studies have indicated that the age of RBCs transfused is associated with increased morbidity and mortality in the critically ill. 18,22,61 The independent association of the amount of RBC transfusions with decreased survival may be related to the increased storage age of RBCs transfused to all patients in our study (33 days). The mean storage age of RBCs transfused per patient was not able to be analyzed as a variable associated with survival since this data were not recorded per patient.…”

“…[3][4][5][6] Strategies or therapeutic principles that can be rapidly applied have the potential to prevent death from hemorrhagic shock and have a significant impact on improving survival for patients with traumatic injuries. 7,8 According to Advanced Trauma Life Support guidelines, the standard approach to the resuscitation of patients with hemorrhagic shock includes the initial bolus of 2 L of crystalloid solutions and then red blood cell (RBC) transfusion. 9 Plasma products are transfused based on the laboratory documentation of coagulopathy.…”

Use of Recombinant Factor Seven (rFVIIa) in the treatment of severe bleeding from trauma

“…While clinical data supporting a reduction in trauma mortality with rFVIIa is unlikely to be forthcoming, these randomized controlled trials do appear to suggest a comparable TEE rate to controls in this patient population [9]. While the first randomized trial has been criticized for insufficient prospective observation for complications, in the CONTROL trial, the 12% overall incidence of TEEs is higher than that reported by previous retrospective series as well as the 3% reported among similarly injured patients in the National Trauma Data Bank, with no increase in TEE in rFVIIa subjects versus controls.…”

Computational modelling of lung injury: is there potential for benefit?

“…Even more respect and admiration is therefore due to those who conduct clinical trials during the very real trials of battle. Outstanding efforts have recently been made by clinicians on the front lines in Afghanistan and Iraq into topics such as traumatic coagulopathy [1][2] and damage control surgery [3], and the important insights gained impact not only on future war casualties, but also on the victims of more mundane but equally fatal trauma closer to home [4].…”