Journal ArticleDOI
Damage Control Hematology: The Impact of a Trauma Exsanguination Protocol on Survival and Blood Product Utilization
Bryan A. Cotton,Bryan A. Cotton,Oliver L. Gunter,James M. Isbell,Brigham K. Au,Amy M. Robertson,John A. Morris,Paul St. Jacques,Pampee P. Young,Pampee P. Young +9 more
TLDR
It is demonstrated that an exsanguination protocol, delivered in an aggressive and predefined manner, significantly reduces the odds of mortality as well as overall blood product consumption.Abstract:
Background: The importance of early and aggressive management of trauma-related coagulopathy remains poorly understood. We hypothesized that a trauma exsanguination protocol (TEP) that systematically provides specified numbers and types of blood components immediately upon initiation of resuscitation would improve survival and reduce overall blood product consumption among the most severely injured patients. Methods: We recently implemented a TEP, which involves the immediate and continued release of blood products from the blood bank in a predefined ratio of 10 units of packed red blood cells (PRBC) to 4 units of fresh frozen plasma to 2 units of platelets. All TEP activations from February 1, 2006 to July 31, 2007 were retrospectively evaluated. A comparison cohort (pre-TEP) was selected from all trauma admissions between August 1, 2004 and January 31, 2006 that (1) underwent immediate surgery by the trauma team and (2) received greater than 10 units of PRBC in the first 24 hours. Multivariable analysis was performed to compare mortality and overall blood product consumption between the two groups. Results: Two hundred eleven patients met inclusion criteria (117 pre-TEP, 94 TEP). Age, sex, and Injury Severity Score were similar between the groups, whereas physiologic severity (by weighted Revised Trauma Score) and predicted survival (by trauma-related Injury Severity Score, TRISS) were worse in the TEP group (p values of 0.037 and 0.028, respectively). After controlling for age, sex, mechanism of injury, TRISS and 24-hour blood product usage, there was a 74% reduction in the odds of mortality among patients in the TEP group (p = 0.001). Overall blood product consumption adjusted for age, sex, mechanism of injury, and TRISS was also significantly reduced in the TEP group (p = 0.015). Conclusions: We have demonstrated that an exsanguination protocol, delivered in an aggressive and predefined manner, significantly reduces the odds of mortality as well as overall blood product consumption.read more
Citations
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Journal ArticleDOI
Increased plasma and platelet to red blood cell ratios improves outcome in 466 massively transfused civilian trauma patients
John B. Holcomb,Charles E. Wade,Joel E. Michalek,Gary B. Chisholm,Lee Ann Zarzabal,Martin A. Schreiber,Ernest A. Gonzalez,Gregory J. Pomper,Jeremy G. Perkins,Phillip C. Spinella,Kari L. Williams,Myung S. Park +11 more
TL;DR: The combination of high plasma and high platelet to RBC ratios were associated with decreased truncal hemorrhage, increased 6-hour, 24 hours, and 30-day survival, and increased intensive care unit, ventilator, and hospital-free days, with no change in multiple organ failure deaths.
Journal ArticleDOI
Management of severe perioperative bleeding Guidelines from the European Society of Anaesthesiology
Sibylle A. Kozek-Langenecker,Arash Afshari,Pierre Albaladejo,Cesar Aldecoa Alvarez Santullano,Edoardo De Robertis,Daniela Filipescu,Dietmar Fries,Thorsten Haas,Georgina Imberger,Matthias Jacob,Marcus D. Lancé,Juan V. Llau,Susan Mallett,Jens Meier,Niels Rahe-Meyer,Charles Marc Samama,Andrew Smith,Cristina Solomon,Philippe Van der Linden,Anne Wikkelsø,Patrick Wouters,Piet Wyffels +21 more
TL;DR: These guidelines are intended to provide an overview of current knowledge on the subject with an assessment of the quality of the evidence in order to allow anaesthetists throughout Europe to integrate this knowledge into daily patient care wherever possible.
Journal ArticleDOI
The prospective, observational, multicenter, major trauma transfusion (PROMMTT) study: Comparative effectiveness of a time-varying treatment with competing risks
John B. Holcomb,Deborah J. del Junco,Erin E. Fox,Charles E. Wade,Mitchell J. Cohen,Martin A. Schreiber,Louis H. Alarcon,Yu Bai,Karen J. Brasel,Eileen M. Bulger,Bryan A. Cotton,Nena Matijevic,Peter Muskat,John G. Myers,Herb A. Phelan,Christopher E. White,Jiajie Zhang,Mohammad H. Rahbar +17 more
TL;DR: Higher plasma and platelet ratios early in resuscitation were associated with decreased mortality in patients who received transfusions of at least 3 units of blood products during the first 24 hours after admission, and among survivors at 24 hours, the subsequent risk of death by day 30 was not associated with plasma or Platelet ratios.
Journal ArticleDOI
Management of bleeding and coagulopathy following major trauma: an updated European guideline
Donat R. Spahn,Bertil Bouillon,Vladimir Cerny,Timothy J Coats,Jacques Duranteau,Enrique Fernández-Mondéjar,Daniela Filipescu,Beverley J. Hunt,Radko Komadina,Giuseppe Nardi,Edmund Neugebauer,Yves Ozier,Louis Riddez,Arthur Schultz,Jean Louis Vincent,Rolf Rossaint +15 more
TL;DR: Key changes encompassed in this version of the guideline include new recommendations on the appropriate use of vasopressors and inotropic agents, and reflect an awareness of the growing number of patients in the population at large treated with antiplatelet agents and/or oral anticoagulants.
This Provisional PDF corresponds to the article as it appeared upon acceptance. Copyedited and fully formatted PDF and full text (HTML) versions will be made available soon. Management of bleeding and coagulopathy following major trauma: an updated European guideline
Donat R. Spahn,Bertil Bouillon,Timothy J Coats,Jacques Duranteau,Enrique Fernández-Mondéjar,Daniela Filipescu,Beverley J. Hunt,Giuseppe Nardi,Edmund Neugebauer,Louis Riddez,Arthur Schultz,Jean Louis Vincent +11 more
TL;DR: In this article, the authors presented an updated version of the guideline published by the Task Force for Advanced Bleeding Care in Trauma and updated in 2010, which included new recommendations on the appropriate use of vasopressors and inotropic agents.
References
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Journal ArticleDOI
Epidemiology of trauma deaths: a reassessment
Angela Sauaia,Frederick A. Moore,Ernest E. Moore,Kathe S. Moser,Regina Brennan,Robert A. Read,Peter T. Pons +6 more
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Journal ArticleDOI
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TL;DR: Improvements in early hemorrhage control and resuscitation and the prevention and aggressive treatment of coagulopathy appear to have the greatest potential to improve outcomes in severely injured trauma patients.
Journal ArticleDOI
Damage control resuscitation: Directly addressing the early coagulopathy of trauma
John B. Holcomb,Donald H. Jenkins,Peter Rhee,Jay A. Johannigman,Peter F. Mahoney,Sumeru G. Mehta,E. Darrin Cox,Michael J. Gehrke,Gregory J. Beilman,Martin A. Schreiber,Stephen F. Flaherty,Kurt W. Grathwohl,Phillip C. Spinella,Jeremy G. Perkins,Alec C. Beekley,Neil R. McMullin,Myung S. Park,Ernest A. Gonzalez,Charles E. Wade,Michael A. Dubick,C. William Schwab,Frederick A. Moore,Howard R. Champion,David B. Hoyt,John R. Hess +24 more
TL;DR: Reports of lactated Ringer s solution and normal saline increasing reperfusion injury and leukocyte adhesion lead one to conclude that the standard crystalloid based resuscitation guidelines in pre hospital trauma life support (PHTLS) and advanced traumaLife support (ATLS) may worsen the presenting acidosis and coagulopathy in severely injured trauma patients, and possibly increase ARDS, SIRS, and MOF.
Journal ArticleDOI
Epidemiology of trauma deaths
TL;DR: The key areas in which advances are necessary in order to reduce the number of trauma deaths are prevention of trauma, more rapid and skilled transport of injured victims, better early management of primary brain injuries, and more effective treatment of the late complications of sepsis and multiple organ failure.
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Damage control resuscitation: Directly addressing the early coagulopathy of trauma
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