Whole blood for trauma patients: Outcomes at higher doses

Richards, Justin E.; Jackson, Bryon

doi:10.1111/trf.16446

Transfusion

2021

DOI: 10.1111/trf.16446

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Whole blood for trauma patients: Outcomes at higher doses

Justin E. Richards

Bryon Jackson

Abstract: See article on page 1710–1720, in this issue

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2021

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Emergency Blood Transfusion for Trauma and Perioperative Resuscitation: Standard of Care

Lier

Fries

2021

Transfus Med Hemother

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Uncontrolled and massive bleeding with derangement of coagulation is a major challenge in the management of both surgical and seriously injured patients. The underlying mechanism of trauma-induced or -associated coagulopathy is tissue injury in the presence of shock and acidosis provoking endothelial damage, activation of inflammation, and coagulation disbalancing. Furthermore, the combination of ongoing blood loss and consumption of blood components that are essential for effective coagulation worsens uncontrolled hemorrhage. Additionally, therapeutic actions, such as resuscitation with replacement fluids or allogeneic blood products, can further aggravate coagulopathy. Of the coagulation factors essential to the clotting process, fibrinogen is the first to be consumed to critical levels during acute bleeding and current evidence suggests that normalizing fibrinogen levels in bleeding patients improves clot formation and clot strength, thereby controlling hemorrhage. Three different therapeutic approaches are discussed controversially. Whole blood transfusion is used especially in the military scenario and is also becoming more and more popular in the civilian world, although it is accompanied by a strong lack of evidence and severe safety issues. Transfusion of allogeneic blood concentrates in fixed ratios without any targets has been investigated extensively with disappointing results. Individualized and target-controlled coagulation management based on point-of-care diagnostics with respect to the huge heterogeneity of massive bleeding situations is an alternative and advanced approach to managing coagulopathy associated with massive bleeding in the trauma as well as the perioperative setting.

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Emergency Blood Transfusion for Trauma and Perioperative Resuscitation: Standard of Care

Lier

Fries

2021

Transfus Med Hemother

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Whole blood for trauma patients: Outcomes at higher doses

Abstract: See article on page 1710–1720, in this issue

Cited by 1 publication

References 23 publications

Emergency Blood Transfusion for Trauma and Perioperative Resuscitation: Standard of Care

Emergency Blood Transfusion for Trauma and Perioperative Resuscitation: Standard of Care

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