Massive transfusion in trauma

Area of Science:

• Emergency Medicine
• Trauma Surgery
• Critical Care

Background:

• Traumatic hemorrhage shock requires prompt intervention, often involving massive transfusion.
• Lack of standardized international definitions for traumatic hemorrhage shock and massive transfusion complicates treatment protocols.

Approach:

• Review of current literature on recommended treatment approaches for traumatic hemorrhage shock.
• Focus on early diagnosis and management of trauma-induced coagulopathy.
• Emphasis on timely substitution of deficiencies using laboratory and viscoelastic tests.

Key Points:

• Massive transfusion is defined as 3-4 packed red blood cells within 1 hour in current literature.
• Early identification and treatment of trauma-induced coagulopathy are essential.
• Standardized laboratory and viscoelastic tests guide deficiency substitution.

Conclusions:

• Massive transfusion protocols facilitate immediate therapy initiation.
• Hemorrhage control via hemostatic dressings and tourniquets is vital.
• Correction of metabolic derangements, along with component therapy (tranexamic acid, fibrinogen, RBCs, plasma, platelets) guided by viscoelastic assays and blood gas analysis, is recommended.
• Whole blood is a viable alternative; additional factors (prothrombin complex, factor XIII, desmopressin) may be needed.