Applying ‘Patient Blood Management’ in the trauma center

Abstract

PURPOSE OF REVIEW: The purpose of this review is to highlight the use of tranexamic acid, point-of-care testing, algorithm-based treatment of trauma-associated coagulopathy with factor concentrates to reduce blood loss and transfusion requirements in order to improve outcome. In addition, the management of patients on new oral anticoagulants, drugs with renewed interest and the tolerance of relatively low hemoglobin levels in the context of trauma will be discussed. RECENT FINDINGS: Early administration of tranexamic acid reduces mortality without increasing the risk of thromboembolic events. Point-of-care testing is increasingly recommended. Goal-directed individualized coagulation algorithms with the use of factor concentrates allow reducing the amount of allogeneic blood products to be administered. Treatment of trauma patients with one of the new oral anticoagulants is challenging. Furthermore, new mechanisms have been discovered such as deep neuromuscular blockade to better tolerate acute anemia. SUMMARY: Applying Patient Blood Management concept to the trauma patient is possible and efficacious. Antihyperfibrinolytics such as tranexamic acid, point-of-care testing and coagulation algorithms with the use of factor concentrates allow a reduction of the number of transfusions, the costs and will likely ameliorate outcome of major trauma patients. Purpose of review The purpose of this review is to highlight the use of tranexamic acid, point-of-care testing, algorithm-based treatment of trauma-associated coagulopathy with factor concentrates to reduce blood loss and transfusion requirements in order to improve outcome. In addition, the management of patients on new oral anticoagulants, drugs with renewed interest and the tolerance of relatively low hemoglobin levels in the context of trauma will be discussed. Recent findingsEarly administration of tranexamic acid reduces mortality without increasing the risk of thromboembolic events. Point-of-care testing is increasingly recommended. Goal-directed individualized coagulation algorithms with the use of factor concentrates allow reducing the amount of allogeneic blood products to be administered. Treatment of trauma patients with one of the new oral anticoagulants is challenging. Furthermore, new mechanisms have been discovered such as deep neuromuscular blockade to better tolerate acute anemia. SummaryApplying Patient Blood Management concept to the trauma patient is possible and efficacious. Antihyperfibrinolytics such as tranexamic acid, point-of-care testing and coagulation algorithms with the use of factor concentrates allow a reduction of the number of transfusions, the costs and will likely ameliorate outcome of major trauma patients.

Infrastructure and clinical practice for the detection and management of trauma-associated haemorrhage and coagulopathy

“…Theusinger et al [25] have demonstrated that blood management concepts to trauma patients are feasible and efficacious and Khan et al [26] have demonstrated that the implementation of haemorrhage protocols may be associated with improved blood product use and patient outcomes in trauma-haemorrhage. The survey by Hoyt et al [16] has similarly reported the frequent use of massive transfusion protocols though a huge heterogeneity was revealed by this survey with respect to the rationale of the treatment algorithm in use.…”

Point of Care and Factor Concentrate-Based Coagulation Algorithms

“…The third example to be mentioned is the algorithm published by Theusinger et al [60,61]. This algorithm also takes into consideration different laboratory and POC results, such as ROTEM, CoaguCheck and Multiplate, and gives clear treatment orders.…”

Role of Pre-Operative Blood Transfusion and Subcutaneous Fat Thickness as Risk Factors for Surgical Site Infection after Posterior Thoracic Spine Stabilization

“…All patients received intravenous single-dose antibiotic prophylaxis (cefazolin) 30 min prior to surgery. If necessary, allogeneic transfusion management and treatment of a potential traumaassociated coagulopathy during the hospital stay followed a fixed algorithm [18].…”