Trauma-Induced Coagulopathy

Abstract

Trauma is the leading cause of death among people under the age of 44. Hemorrhage is a major contributor to deaths related to trauma in the first 48 h. Accordingly, the management of these patients is a time-sensitive and critical affair that anesthesiologists responsible for surgical resuscitation will face. Coagulopathy associated with trauma exists in one-third of all severely injured patients upon presentation to the hospital. Trauma patients presenting with coagulopathy have significantly higher mortality. This trauma-induced coagulopathy (TIC) must be managed adroitly in the resuscitation of these patients. Recent advancements in our understanding of TIC have led to new protocols and therapy guidelines. Anesthesiologists must be aware of these to effectively manage this form of shock. TIC driven by a combination of endogenous biological processes, as well as iatrogenic causes, can ultimately lead to the lethal triad of hypothermia, acidemia, and coagulopathy. Providers should understand how to promptly diagnose TIC and be aware of the early indicators of massive transfusion. The use of common laboratory studies and patient vital signs serve as our current guide, but the importance of each is still under debate. Thromboelastography is a tool used often in the diagnosis of TIC and can be used to guide blood product transfusion. Certain pharmaceutical strategies and non-transfusion strategies also exist, which aid in the management of hemorrhagic shock. Damage control surgery, rewarming, tranexamic acid, and 1:1:1 transfusion protocols are promising methods used to treat the critically wounded. Though protocols have been developed, controversies still exist on the optimal resuscitation strategy.

In vitro evaluation of the hyaluronic acid/alginate composite powder for topical haemostasis and wound healing

“…Uncontrolled and significant haemorrhage caused by traumatic injuries on both compressible and noncompressible sites in the battlefield and civilian situations can remarkably raise the prehospital and potentially preventable mortality, which is a consequence of hypothermia, infection, coagulopathy, and multiple organ failure . Intraoperative massive loss of blood can also occur during emergency and medical surgeries, such as hepatic, urologic, and cardiovascular surgeries, and elevates the incident of haemorrhage‐related morbidity and mortality .…”

Trauma-induced coagulopathy and critical bleeding: the role of plasma and platelet transfusion

“…This has led to the use of a new terminology: acute traumatic coagulopathy (ATC) or acute coagulopathy of trauma shock, or trauma-induced coagulopathy (TIC). ATC/TIC quickly follows severe and profound injury and is present in one quarter to one third of these patients at the time of hospital admission [14,15].…”

Massive transfusion

“…In the last decade, an alternative resuscitation strategy based on giving only the conventional blood components plasma, platelets, and red blood cells (RBCs) in a 1 : 1 : 1 unit ratio to provide intravascular volume, oxygen carrying capacity, plasma coagulation factors, and functioning platelets, while markedly limiting crystalloid fluids and avoiding other colloid-containing fluids, has been widely adopted for massively bleeding, severely injured patients and appears to save lives and reduce blood product consumption in this small but highly transfused group [1 && ,2 occurred late in the course of bleeding. We now know that an acute coagulopathy of trauma (ACoT) occurs quickly after severe and profound injury and is present in one-quarter to one-third of such patients at the time of hospital admission [4,5].…”