Effect of a fixed-ratio (1:1:1) transfusion protocol versus laboratory-results–guided transfusion in patients with severe trauma: a randomized feasibility trial

Nascimento, Bartolomeu; Callum, Jeannie; Tien, Homer; Rubenfeld, Gordon D.; Pinto, Ruxandra; Lin, Yulia; Rizoli, Sandro

doi:10.1503/cmaj.121986

Cited by 111 publications

(121 citation statements)

References 22 publications

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“…56 Unquestionably, clear clinical goals for when to stop the MTP should be in place. 57 When discussing different ratios of plasma, platelets, and RBCs for massively hemorrhaging patients, it should be emphasized that the timing of such therapy is pivotal for the success of the resuscitation. Riskin and colleagues reported a reduction in mortality from 45% to 19% after the implementation of an MTP.…”

Section: Discussionmentioning

confidence: 99%

How I treat patients with massive hemorrhage

Johansson

Stensballe

Oliveri

et al. 2014

Blood

173

125

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Massive hemorrhage is associated with coagulopathy and high mortality. The transfusion guidelines up to 2006 recommended that resuscitation of massive hemorrhage should occur in successive steps using crystalloids, colloids, and red blood cells (RBCs) in the early phase and plasma and platelets in the late phase. With the introduction of the cell-based model of hemostasis in the mid-1990s, our understanding of the hemostatic process and of coagulopathy has improved. This has contributed to a change in resuscitation strategy and transfusion therapy of massive hemorrhage along with an acceptance of the adequacy of whole blood hemostatic tests to monitor these patients. Thus, in 2005, a strategy aiming at avoiding coagulopathy by proactive resuscitation with blood products in a balanced ratio of RBC:plasma:platelets was introduced, and this has been reported to be associated with reduced mortality in observational studies. Concurrently, whole blood viscoelastic hemostatic assays have gained acceptance by allowing a rapid and timely identification of coagulopathy along with enabling an individualized, goal-directed transfusion therapy. These strategies joined together seem beneficial for patient outcome, although final evidence on outcome from randomized controlled trials are lacking. We present how we in Copenhagen and Houston, today, manage patients with massive hemorrhage.

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Section: Discussionmentioning

confidence: 99%

How I treat patients with massive hemorrhage

Johansson

Stensballe

Oliveri

et al. 2014

Blood

173

125

View full text Add to dashboard Cite

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“…Time to delivery of product replacement in PROPPR was rapidly achieved without significant wastage but this is dependent on having thawed product available 24 hours a day in either the trauma unit or blood bank (52). The impressive delivery of blood component therapy as described in the PROPPR trial may be difficult to translate into routine clinical practise (53). A recent study from Stanworth et al reports widespread variations in patterns of blood product delivery across a number of trauma centres, with few patients receiving an 'optimal' product ratio (54).…”

Section: Major Haemorrhage Protocols (Mhp)mentioning

confidence: 99%

Fibrinogen in traumatic haemorrhage: A narrative review

Winearls

Campbell

Hurn

et al. 2017

Injury

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Abstract:Haemorrhage in the setting of severe trauma is associated with significant morbidity and mortality. There is increasing awareness of the important role fibrinogen plays in traumatic haemorrhage. Fibrinogen levels fall precipitously in severe trauma and the resultant hypofibrinogenaemia is associated with poor outcomes. Hence, it has been postulated that early fibrinogen replacement in severe traumatic haemorrhage may improve outcomes, although, to date there is a paucity of high quality evidence to support this hypothesis. In addition there is controversy regarding the optimal method for fibrinogen supplementation. We review the current evidence regarding the role of fibrinogen in trauma, the rationale behind fibrinogen supplementation and discuss current research.

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“…[24][25][26][27][28][29] A single centre pilot randomized controlled trial failed to show a survival benefit of this hemostatic resuscitation strategy. 30 However, a larger multicentred randomized controlled trial has just been completed, and the results are still pending. 31 The administration of tranexamic acid (TXA) is another cornerstone in hemostatic resuscitation, as it also treats coagulopathy by targeting one of the underlying mechanisms in the development of trauma associated coagulopathy: fibrinolysis.…”

Section: Damage Control Resuscitationmentioning

confidence: 99%