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Potential value of protocols in substantially bleeding trauma patients.
1Division of Acute Care Surgery, Center for Translational Injury Research, University of Texas Health Science Center, Houston, Texas, USA. John.Holcomb@uth.tmc.edu
Current Opinion in Anaesthesiology
|February 7, 2013
Summary
Early identification of traumatic coagulopathy and massive blood loss is crucial. Substantial bleeding protocols (SBPs) improve outcomes by standardizing blood product ratios and enhancing communication for trauma patients.
Area of Science:
- Trauma Management
- Hemorrhagic Shock
- Coagulopathy
Background:
- Hemorrhage causes nearly 50% of trauma deaths within 24 hours.
- Immediate post-injury mortality is largely preventable.
- Early identification of coagulopathy is key.
Purpose of the Study:
- Review advancements in early traumatic coagulopathy.
- Discuss the role of substantial bleeding protocols (SBPs).
- Improve trauma resuscitation strategies.
Main Methods:
- Analysis of survivor bias in trauma resuscitation.
- Examination of fresh frozen plasma to red blood cell ratios.
- Review of the PROMMTT study data.
Main Results:
- Accounting for survivor bias can improve outcomes.
- Higher fresh frozen plasma: red blood cell ratios are beneficial.
- The PROMMTT study showed variable infusion practices and improved outcomes with higher ratios.
Conclusions:
- SBPs address organizational needs for massive blood loss response.
- SBPs reduce provider variability and improve communication.
- Transfusion subcommittees are vital for SBP implementation.
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