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Massive transfusion and nonsurgical hemostatic agents.

Jeremy G Perkins1, Andrew P Cap, Brendan M Weiss

  • 1Hematology/Oncology Service, Walter Reed Army Medical Center, Washington, DC, USA. jeremy.perkins1@us.army.mil

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Massive transfusion is critical for severe trauma, especially in combat casualties, to prevent death. Early prediction and management of hemorrhage, including blood product transfusion, can significantly reduce mortality.

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Area of Science:

  • Trauma care
  • Hemorrhagic shock management
  • Massive transfusion protocols

Background:

  • Hemorrhage accounts for 30-40% of trauma fatalities, being the leading preventable cause of death in combat casualties.
  • Massive transfusion, defined as ≥10 units of blood in 24 hours, is crucial for severe hemorrhage but uncommon in civilian trauma.
  • Early prediction and aggressive management of hemorrhage are key to reducing early mortality in trauma patients.

Purpose of the Study:

  • To review clinical problems associated with massive transfusion.
  • To survey nonsurgical hemorrhage management strategies.
  • To highlight the importance of early intervention in severe hemorrhage.

Main Methods:

  • Literature review of clinical problems and nonsurgical management of hemorrhage.
  • Analysis of massive transfusion definitions and incidence in civilian and combat trauma.
  • Survey of blood product transfusion, hemostatic agents, and medications.

Main Results:

  • Massive transfusion is defined variably, most commonly as ≥10 units/24h.
  • Incidence of massive transfusion is higher in combat casualties (8-16%) compared to civilian trauma (1-3%).
  • Massive transfusion, while reducing early mortality, carries risks and requires significant resources.

Conclusions:

  • Nonsurgical management includes blood products, hemostatic bandages/agents, and medications.
  • Effective hemorrhage control and timely massive transfusion are vital for improving outcomes in severe trauma.
  • Further research and standardized protocols are needed to optimize massive transfusion practices and mitigate risks.