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Trauma-associated bleeding: management of massive transfusion.
Christopher T Stephens1, Sam Gumbert, John B Holcomb
1aDepartment of Anesthesiology, Division of Trauma Anesthesiology bCenter for Translational Injury Research cDepartment of Surgery, Division of Acute Care Surgery, The University of Texas Health Science Center at Houston, Houston, Texas, USA.
Current Opinion in Anaesthesiology
|February 3, 2016
Summary
Early, balanced blood product resuscitation using a 1:1:1 ratio significantly decreases mortality in trauma patients. This approach, including hemostatic assays and goal-directed therapy, is key for managing massive hemorrhage.
Area of Science:
- Trauma resuscitation
- Hemorrhagic shock management
- Massive transfusion protocols
Background:
- Traditional resuscitation strategies for bleeding trauma patients are evolving.
- Recent research highlights improved outcomes with aggressive, balanced blood product administration.
Purpose of the Study:
- To review recent advances in managing bleeding trauma patients.
- To discuss the shift in early treatment goals for trauma-induced hemorrhage.
Main Methods:
- Review of recent data on blood product resuscitation.
- Integration of bedside viscoelastic hemostatic assays.
- Application of hemostatic resuscitation and goal-directed therapy.
Main Results:
- Evidence supports early 1:1:1 ratio blood product transfusion (plasma:platelets:red blood cells).
- This balanced approach restores circulating volume, oxygen capacity, and clotting factors.
- Combined strategies improve outcomes in massively bleeding trauma patients.
Conclusions:
- The 1:1:1 transfusion protocol is evidence-based for trauma hemorrhage.
- Further research is needed on prehospital blood product initiation and adjuncts.
- Aggressive, balanced resuscitation is critical for reducing mortality in bleeding trauma.
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