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
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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.Abstract:
Objective To relate in-hospital mortality to early transfusion of plasma and/or platelets and to time-varying plasma:red blood cell (RBC) and platelet:RBC ratios. Design Prospective cohort study documenting the timing of transfusions during active resuscitation and patient outcomes. Data were analyzed using time-dependent proportional hazards models. Setting Ten US level I trauma centers. Patients Adult trauma patients surviving for 30 minutes after admission who received a transfusion of at least 1 unit of RBCs within 6 hours of admission (n = 1245, the original study group) and at least 3 total units (of RBCs, plasma, or platelets) within 24 hours (n = 905, the analysis group). Main Outcome Measure In-hospital mortality. Results Plasma:RBC and platelet:RBC ratios were not constant during the first 24 hours (P Conclusions 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. Among survivors at 24 hours, the subsequent risk of death by day 30 was not associated with plasma or platelet ratios.read more
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Leukocyte filtration lesion impairs functional coagulation in banked whole blood.
TL;DR: Filtered WB had decreased functional clotting capacity and thrombin generation and may not be suitable for hemostatic resuscitation as the sole blood product.
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Blood Component Therapy and Coagulopathy in Trauma: A Systematic Review of the Literature from the Trauma Update Group.
Daniele Poole,Andrea Cortegiani,Arturo Chieregato,Emanuele Russo,Concetta Pellegrini,Elvio De Blasio,Francesca Mengoli,Annalisa Volpi,Silvia Grossi,Lara Gianesello,Vanni Orzalesi,Francesca Fossi,Osvaldo Chiara,Carlo Coniglio,Giovanni Gordini +14 more
TL;DR: The use of tranexamic acid in trauma was supported by “high” quality evidence according to the GRADE classification but was downgraded to “moderate” for external validity issues.
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Potential value of protocols in substantially bleeding trauma patients.
John B. Holcomb,Sam D. Gumbert +1 more
TL;DR: This review will discuss the recent changes and advancement of early traumatic coagulopathy and the important role of substantial bleeding protocols (SBPs) and the variable nature of infusion, the importance of time and improved outcomes with higher product ratios.
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Emergency Medicine Evaluation and Management of Anemia.
Brit Long,Alex Koyfman +1 more
TL;DR: Most patients with chronic anemia may be discharged with follow-up if hemodynamically stable, and iron is an alternative treatment for patients with microcytic anemia owing to iron deficiency.
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Anaesthesia considerations in penetrating trauma
TL;DR: This review article aims to cover basic principles of attending to penetrating trauma victims starting at the pre-hospital level and continuing into the emergency department (ED) and the operating theatre, and suggest a work flow for treating life-threatening penetrating injury.
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TL;DR: The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Initiative developed recommendations on what should be included in an accurate and complete report of an observational study, resulting in a checklist of 22 items that relate to the title, abstract, introduction, methods, results, and discussion sections of articles.
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