Transfusion Management in Trauma: What is Current Best Practice?

Beiriger, Jamison; Silver, David; Lu, Liling; Brown, Joshua B.

doi:10.1007/s40137-023-00352-1

Cited by 4 publications

(7 citation statements)

References 100 publications

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“…For HS: permissive hypotension; 15 mg/kg tranexamic acid; fibrinogen aiming at 2.2--2.5 g/l; PCC 25 >0.9 mmol/l [6 && ] and introduced the term "death diamond" [22]. Figure 1…”

Section: Key Pointsmentioning

confidence: 99%

“…Synthetic colloids should be avoided [16 ▪▪ ]. Contemporary strategies minimize balanced crystalloid use (“restrictive volume replacement strategy”) [16 ▪▪ ,25 ▪ ].…”

Section: Therapymentioning

confidence: 99%

“…FFP should be group-identical to the patient. Group A plasma is now also available for untyped patients demonstrating noninferiority to AB-plasma, the impact of plasma ABO-incompatibility on clinical outcomes is insignificant [25 ▪ ]. Being a superior isometric buffer compared to crystalloids, plasma is an ideal volume expander in the intravascular space, has a homeostatic effect on endothelial function and innate immune system activation [25 ▪ ,32].…”

Section: Plasmamentioning

confidence: 99%

“…Group A plasma is now also available for untyped patients demonstrating noninferiority to AB-plasma, the impact of plasma ABO-incompatibility on clinical outcomes is insignificant [25 ▪ ]. Being a superior isometric buffer compared to crystalloids, plasma is an ideal volume expander in the intravascular space, has a homeostatic effect on endothelial function and innate immune system activation [25 ▪ ,32]. FFP-based resuscitation improves intestinal perfusion immediately following resuscitation, which correlates with improved tissue oxygenation and decreased tissue CO 2 -levels [33].…”

Section: Plasmamentioning

confidence: 99%

“…A post hoc analysis using Bayesian hierarchical models indicated “strong” to “decisive” supporting evidence in favor of balanced transfusions [37]. Almost all international guidelines recommend this ratio as initial therapy in MT: RBC and plasma initially in a 1 : 1 ratio (not less than 2 : 1) [16 ▪▪ ,17 ▪▪ ,26 ▪▪ ]; RBC:FFP:PC in a 1 : 1:1 (using US PC) [25 ▪ ] or 4 : 4:1 ratio (using Australian or German pooled or apheresis PC) [14 ▪▪ ,15 ▪▪ ], respectively; and a high PC:RBC ratio [17 ▪▪ ]. Using the Trauma Quality Improvement Program database, for patients receiving >10 pRBC, increasing RBC:PC and RBC:FFP ratios were consistently associated with increased odds of 4h-mortality [38 ▪ ].…”

Section: Ratiomentioning

confidence: 99%

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Massive transfusion in trauma

Lier,

Hossfeld

2024

Current Opinion in Anaesthesiology

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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.

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“…For HS: permissive hypotension; 15 mg/kg tranexamic acid; fibrinogen aiming at 2.2--2.5 g/l; PCC 25 >0.9 mmol/l [6 && ] and introduced the term "death diamond" [22]. Figure 1…”

Section: Key Pointsmentioning

confidence: 99%

“…Synthetic colloids should be avoided [16 ▪▪ ]. Contemporary strategies minimize balanced crystalloid use (“restrictive volume replacement strategy”) [16 ▪▪ ,25 ▪ ].…”

Section: Therapymentioning

confidence: 99%

Section: Plasmamentioning

confidence: 99%

Section: Plasmamentioning

confidence: 99%

Section: Ratiomentioning

confidence: 99%

See 3 more Smart Citations

Massive transfusion in trauma

Lier,

Hossfeld

2024

Current Opinion in Anaesthesiology

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Evaluation of Tranexamic Acid and Calcium Chloride in Major Traumas in a Pre-hospital Setting: Narrative Review

Bell

Salmon

Purdy

et al. 2023

Shock

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Excessive blood loss in the pre-hospital setting poses a significant challenge and is one of the leading causes of death in the United States. In response, emergency medical services (EMS) have increasingly adopted the use of tranexamic acid (TXA) and calcium chloride (CaCl2) as therapeutic interventions for hemorrhagic traumas. TXA functions by inhibiting plasmin formation and restoring hemostatic balance, while calcium plays a pivotal role in the coagulation cascade, facilitating the conversion of factor X to factor Xa and prothrombin to thrombin. Despite the growing utilization of TXA and CaCl2 in both pre-hospital and hospital environments, a lack of literature exists regarding the comparative effectiveness of these agents in reducing hemorrhage and improving patient outcomes. Notably, Morgan County Indiana EMS, recently integrated the administration of TXA with CaCl2 into their treatment protocols, offering a valuable opportunity to gather insight and formulate updated guidelines based on patient-centered outcomes. This narrative review aims to comprehensively evaluate the existing evidence concerning the administration of TXA and CaCl2 in the pre-hospital management of hemorrhages, while also incorporating and analyzing data derived from the co-administration of these medications within the practices of Morgan County EMS. This represents the inaugural description of the concurrent use of both TXA and CaCl2 to manage hemorrhages in the scientific literature.

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Post-Reconstitution Hemostatic Stability Profiles of Canadian and German Freeze-Dried Plasma

Peng,

Moes,

Singh

et al. 2024

Life

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Despite the importance of the hemostatic properties of reconstituted freeze-dried plasma (FDP) for trauma resuscitation, few studies have been conducted to determine its post-reconstitution hemostatic stability. This study aimed to assess the short- (≤24 h) and long-term (≥168 h) hemostatic stabilities of Canadian and German freeze-dried plasma (CFDP and LyoPlas) after reconstitution and storage under different conditions. Post-reconstitution hemostatic profiles were determined using rotational thromboelastometry (ROTEM) and a Stago analyzer, as both are widely used as standard methods for assessing the quality of plasma. When compared to the initial reconstituted CFDP, there were no changes in ROTEM measurements for INTEM maximum clot firmness (MCF), EXTEM clotting time (CT) and MCF, and Stago measurements for prothrombin time (PT), partial thromboplastin time (PTT), D-dimer concentration, plasminogen, and protein C activities after storage at 4 °C for 24 h and room temperature (RT) (22–25 °C) for 4 h. However, an increase in INTEM CT and decreases in fibrinogen concentration, factors V and VIII, and protein S activities were observed after storage at 4 °C for 24 h, while an increase in factor V and decreases in antithrombin and protein S activities were seen after storage at RT for 4 h. Evaluation of the long-term stability of reconstituted LyoPlas showed decreased stability in both global and specific hemostatic profiles with increasing storage temperatures, particularly at 35 °C, where progressive changes in CT and MCF, PT, PTT, fibrinogen concentration, factor V, antithrombin, protein C, and protein S activities were seen even after storage for 4 h. We confirmed the short-term stability of CFDP in global hemostatic properties after reconstitution and storage at RT, consistent with the shelf life of reconstituted LyoPlas. The long-term stability analyses suggest that the post-reconstitution hemostatic stability of FDP products would decrease over time with increasing storage temperature, with a significant loss of hemostatic functions at 35 °C compared to 22 °C or below. Therefore, the shelf life of reconstituted FDP should be recommended according to the storage temperature.

show abstract

Transfusion Management in Trauma: What is Current Best Practice?

Cited by 4 publications

References 100 publications

Massive transfusion in trauma

Massive transfusion in trauma

Evaluation of Tranexamic Acid and Calcium Chloride in Major Traumas in a Pre-hospital Setting: Narrative Review

Post-Reconstitution Hemostatic Stability Profiles of Canadian and German Freeze-Dried Plasma

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