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Coagulation challenges after severe injury with hemorrhagic shock
Anna M Ledgerwood1, William Blaisdell
1Department of Surgery, Wayne State University, Detroit, Michigan 48201, USA. aledgerw@med.wayne.edu
The Journal of Trauma and Acute Care Surgery
|June 15, 2012
Summary
Over 50 years, treatment for bleeding in traumatic hemorrhagic shock (HS) evolved from whole blood to component therapy. Current approaches emphasize early fresh frozen plasma (FFP) and balanced resuscitation strategies.
Area of Science:
- Trauma and Emergency Medicine
- Hematology
- Critical Care Medicine
Background:
- Treatment for coagulopathic bleeding in traumatic hemorrhagic shock (HS) has evolved significantly over five decades.
- Early approaches in the 1960s used balanced electrolyte solutions (BES) and whole blood, with coagulopathy managed by replacing labile factors.
- Component therapy, introduced in the 1970s, shifted treatment to BES and packed red blood cells (RBC), necessitating careful management of fresh frozen plasma (FFP) for coagulation factor replacement.
Purpose of the Study:
- To review the historical evolution of managing coagulopathic bleeding in traumatic hemorrhagic shock.
- To examine the changing paradigms in resuscitation strategies, including the use of component therapy and specific blood products.
- To discuss the emergence and management of disseminated intravascular coagulation (DIC) in the context of HS.
Main Methods:
- Historical review of treatment protocols for traumatic hemorrhagic shock and associated coagulopathy.
- Analysis of the changing recommendations for blood product transfusion, including whole blood, packed red blood cells, and fresh frozen plasma.
- Examination of the understanding and management of disseminated intravascular coagulation (DIC) in critically injured patients.
Main Results:
- Treatment evolved from whole blood to component therapy (RBC, FFP), with a shift towards earlier FFP administration based on evolving evidence.
- The 1980s saw increased FFP use, leading to restrictions, while the 1990s supported proactive FFP administration.
- Military surgeons promoted a 1:1:1 ratio of platelets, RBC, and FFP in the 2010s, with ongoing assessment.
- Disseminated intravascular coagulation (DIC) remains a complex complication of HS, with limited success in traditional anticoagulant or antifibrinolytic therapies.
Conclusions:
- The management of coagulopathic bleeding in HS has transitioned through distinct phases, emphasizing a move towards early and balanced resuscitation.
- The role of FFP and other blood products has been redefined, with current trends favoring proactive administration.
- Disseminated intravascular coagulation (DIC) in HS is a persistent challenge, requiring further research for effective therapeutic strategies.
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