Novel concepts for damage control resuscitation in trauma

Area of Science:

• Trauma resuscitation
• Hemorrhagic shock management
• Blood product transfusion

Background:

• Traumatic injuries are a leading cause of global mortality.
• Damage control resuscitation (DCR) with a 1:1:1 ratio of plasma, platelets, and red blood cells is standard for exsanguinating hemorrhage.
• Availability of plasma and platelets can be challenging in certain settings.

Purpose of the Study:

• To review literature on alternatives for achieving the 1:1:1 transfusion ratio in trauma resuscitation.
• To explore substitutes for plasma and platelets when they are not readily available.

Main Methods:

• Literature review of studies on trauma resuscitation and blood product alternatives.
• Analysis of findings regarding the efficacy and logistics of different transfusion strategies.

Main Results:

• Liquid and freeze-dried plasma (FDP) offer logistical advantages and potential superiority over fresh frozen plasma.
• Cold-stored platelets (CSPs) exhibit enhanced hemostatic properties and better resistance to bacterial contamination.
• Low titer type O whole blood is a safe option for civilian trauma patients.

Conclusions:

• Resuscitation for traumatic hemorrhagic shock should prioritize a 1:1:1 plasma, platelet, and red blood cell ratio with minimal crystalloids.
• When plasma and platelets are limited, low titer type O whole blood, liquid plasma, FDP, or CSPs are viable alternatives.
• CSPs may offer superior hemostatic function compared to room temperature platelets.