Hemostatic Resuscitation During Surgery Improves Survival in Patients With Traumatic-Induced Coagulopathy

Duchesne, Juan; Islam, Tareq; Stuke, Lance; Timmer, Jeremy R.; Barbeau, J. Mills; Marr, Alan B.; Hunt, John P.; DellaVolpe, Jeffrey; Wahl, Georgia; Greiffenstein, Patrick; Steeb, Glen; McGinness, Clifton; Baker, Christopher C.; McSwain, Norman E.

doi:10.1097/ta.0b013e31819adb8e

Cited by 89 publications

(71 citation statements)

References 24 publications

(26 reference statements)

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“…Nonetheless, the differences in survival were dramatic, and similar observations were soon reported from civilian trauma centres and aggregated registries 24 . There have been more than 20 publications on this topic in the past 3 years 25,34,35 . Methodologies designed to account for early mortality show less impressive, but still positive, results 26 .…”

Section: Management Of Blood Contentmentioning

confidence: 99%

Resuscitative strategies to maintain homeostasis during damage control surgery

Dutton

2011

British Journal of Surgery

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Background: Successful outcome from damage control surgery (DCS) depends as much on elements of resuscitation and non-operative management as on details of the procedure itself. The early management of patients in haemorrhagic shock has undergone substantial revision in the past decade and is now known as 'haemostatic resuscitation'.Methods: An updated literature review describing the anaesthetic and resuscitative management of patients with active, ongoing traumatic haemorrhage was distilled to present the current knowledge of the pathophysiology, recommended treatments and areas of active controversy.Results: Current practice in military and civilian trauma centres is described, along with the degree of evidence in support of clinical decisions. Resuscitation of patients with ongoing traumatic haemorrhage has changed substantially in the past two decades. Optimal management now includes deliberate hypotension to minimize blood loss, early use of blood products (especially plasma) and administration of antifibrinolytic therapy. Areas of debate include the role of clotting factor concentrates and depth of anaesthesia. Conclusion: Resuscitation strategies during DCS may be as important as the anatomical repair itself.Recommendations include avoidance of hypothermia, maintenance of a lower than normal blood pressure, and early support of the coagulation system in patients likely to require massive transfusion. Controversies include the optimal ratio of plasma to red blood cells for empirical resuscitation, the ideal role of clotting factor concentrates, and the potential benefit of early, deep anaesthesia. Future research will centre on the complex interaction between the humoral elements of coagulation and the vascular endothelium that regulates perfusion, clotting and integrity of the circulation.

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Section: Management Of Blood Contentmentioning

confidence: 99%

Resuscitative strategies to maintain homeostasis during damage control surgery

Dutton

2011

British Journal of Surgery

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“…Napolitano reviewed the cumulative risks of early RBC transfusion in trauma and considered the adverse effects to be owing to increasing incidence of SIRS, immunomodulation and microcirculatory dysfunction [76]. However, haemostatic resuscitation during surgery with high ratios of FFP to PRBC in patients with TIC improves survival [77]. These studies emphasize the requirement to make a rapid diagnosis, hence appropriate treatment can be given and tailored to patients requiring haemostatic resuscitation and those patients not requiring such intervention are not exposed to the unnecessary risks.…”

Section: Massive Haemorrhage Protocolsmentioning

confidence: 99%

Resuscitation and coagulation in the severely injured trauma patient

Midwinter

Woolley

2011

Phil. Trans. R. Soc. B

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Developments in the resuscitation of the severely injured trauma patient in the last decade have been through the increased understanding of the early pathophysiological consequences of injury together with some observations and experiences of recent casualties of conflict. In particular, the recognition of early derangements of haemostasis with hypocoagulopathy being associated with increased mortality and morbidity and the prime importance of tissue hypoperfusion as a central driver to this process in this population of patients has led to new resuscitation strategies. These strategies have focused on haemostatic resuscitation and the development of the ideas of damage control resuscitation and damage control surgery continuum. This in turn has led to a requirement to be able to more closely monitor the physiological status, of major trauma patients, including their coagulation status, and react in an anticipatory fashion.

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“…An INR >1.2 was considered indicative of coagulopathy, in accordance with previous studies. [16,17] Missing blood results in the first hour of admission were excluded from the study. The mechanism of injury was obtained from the patient's electronic chart.…”

Section: Researchmentioning

confidence: 99%