Intra-operative correction of acidosis, coagulopathy and hypothermia in combat casualties with severe haemorrhagic shock

Abstract

We assessed acidosis, coagulopathy and hypothermia, before and after surgery in 51 combat troops operated on for severe blast injury. Patients were transfused a median (IQR [range]) of 27 (17-38 [5-84]) units of red cell concentrate, 27 (16-38 [4-83]) units of plasma, 2.0 (0.5-3.5 [0-13.0]) units of cryoprecipitate and 4 (2-6 [0-17]) pools of platelets. The pH, base excess, prothrombin time and temperature increased: from 7.19 (7.10-7.29 [6.50-7.49]) to 7.45 (7.40-7.51 [7.15-7.62]); from -9.0 (-13.5 to -4.5 [-28 to -2]) mmol.l⁻¹ to 4.5 (1.0-8.0 [-7 to +11]) mmol.l⁻¹; from 18 (15-21 [9-24]) s to 14 (11-18 [9-21]) s; and from 36.1 (35.1-37.1 [33.0-38.1]) °C to 37.4 (37.0-37.9 [36.0-38.0]) °C, respectively. Contemporary intra-operative resuscitation strategies can normalise the physiological derangements caused by haemorrhagic shock.

Prehospital blood transfusion in the en route management of severe combat trauma

“…3B). 15 These patients often need extensive debridement, which, in the context of normotension with euvolemia, may require considerable transfusion support. In addition, the FFP/PRBC ratio differed markedly between the matched groups.…”

“…4,11 Taken together, these are known as damage control resuscitation (DCR). 15,16 En route care, that is, during transport from point of injury to admission to a field hospital, has also been enhanced with the development of physician-led clinical teams delivering treatment during helicopter transportation from point of wounding to hospital. 15,16 En route care, that is, during transport from point of injury to admission to a field hospital, has also been enhanced with the development of physician-led clinical teams delivering treatment during helicopter transportation from point of wounding to hospital.…”

Hypothermia: effects on platelet function and hemostasis

“…In trauma patients, extra precautions are required based on inherent bias due to absolute or relative hypovolemia and acidosis [ 25 ].…”

Pooled platelet ratio in damage control resuscitation

“…I read with great interest the systematic review by Moyce et al, on interventions to decrease post-operative delirium [1]. I congratulate the authors as much on their choice of subject as on the detailed work they have done.…”