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Standardized Hemorrhagic Shock Induction Guided by Cerebral Oximetry and Extended Hemodynamic Monitoring in Pigs

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Transfusion therapy in hemorrhagic shock.

Timothy C Nunez¹, Bryan A Cotton

¹Department of Surgery, Brooke Army Medical Center, Fort Sam Houston, USA.

Current Opinion in Critical Care

|September 5, 2009

Summary

Early blood product transfusion, including plasma and platelets with red blood cells, improves survival in trauma patients with acute coagulopathy. This damage control resuscitation strategy is crucial for exsanguinating patients.

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Area of Science:

Trauma critical care
Hemorrhagic shock management
Massive transfusion protocols

Background:

Hemorrhage is a leading cause of death in trauma patients.
Resuscitation strategies have evolved, influenced by military experience.
Acute coagulopathy of trauma affects a significant percentage of patients.

Purpose of the Study:

To review the damage control resuscitation strategy.
To focus on early and frequent transfusion of blood products (red cells, plasma, platelets).
To discuss the optimal ratios of blood products in massive transfusion.

Main Methods:

Review of available data and retrospective studies.
Analysis of outcomes in trauma patients receiving early blood product transfusion.
No randomized controlled trials currently exist comparing damage control hematology to traditional methods.

Main Results:

Overwhelming data supports high ratios of plasma and platelets to packed red blood cells.
Retrospective studies suggest ratios near 1:1 improve survival.
Early identification of coagulopathy and initiation of damage control hematology are linked to better outcomes.

Conclusions:

Acute coagulopathy of trauma is prevalent.
Early damage control hematology improves outcomes for massive transfusion patients.
Data suggests a plasma-to-packed red blood cell ratio greater than 2:3 is beneficial.