Transfusion Management in Trauma: What is Current Best Practice?

Beiriger, Jamison; Silver, David; Lu, Liling; Brown, Joshua B.

doi:10.1007/s40137-023-00352-1

Cited by 3 publications

(6 citation statements)

References 100 publications

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“…For HS: permissive hypotension; 15 mg/kg tranexamic acid; fibrinogen aiming at 2.2--2.5 g/l; PCC 25 >0.9 mmol/l [6 && ] and introduced the term "death diamond" [22]. Figure 1…”

Section: Key Pointsmentioning

confidence: 99%

“…Synthetic colloids should be avoided [16 ▪▪ ]. Contemporary strategies minimize balanced crystalloid use (“restrictive volume replacement strategy”) [16 ▪▪ ,25 ▪ ].…”

Section: Therapymentioning

confidence: 99%

“…FFP should be group-identical to the patient. Group A plasma is now also available for untyped patients demonstrating noninferiority to AB-plasma, the impact of plasma ABO-incompatibility on clinical outcomes is insignificant [25 ▪ ]. Being a superior isometric buffer compared to crystalloids, plasma is an ideal volume expander in the intravascular space, has a homeostatic effect on endothelial function and innate immune system activation [25 ▪ ,32].…”

Section: Plasmamentioning

confidence: 99%

“…Group A plasma is now also available for untyped patients demonstrating noninferiority to AB-plasma, the impact of plasma ABO-incompatibility on clinical outcomes is insignificant [25 ▪ ]. Being a superior isometric buffer compared to crystalloids, plasma is an ideal volume expander in the intravascular space, has a homeostatic effect on endothelial function and innate immune system activation [25 ▪ ,32]. FFP-based resuscitation improves intestinal perfusion immediately following resuscitation, which correlates with improved tissue oxygenation and decreased tissue CO 2 -levels [33].…”

Section: Plasmamentioning

confidence: 99%

“…A post hoc analysis using Bayesian hierarchical models indicated “strong” to “decisive” supporting evidence in favor of balanced transfusions [37]. Almost all international guidelines recommend this ratio as initial therapy in MT: RBC and plasma initially in a 1 : 1 ratio (not less than 2 : 1) [16 ▪▪ ,17 ▪▪ ,26 ▪▪ ]; RBC:FFP:PC in a 1 : 1:1 (using US PC) [25 ▪ ] or 4 : 4:1 ratio (using Australian or German pooled or apheresis PC) [14 ▪▪ ,15 ▪▪ ], respectively; and a high PC:RBC ratio [17 ▪▪ ]. Using the Trauma Quality Improvement Program database, for patients receiving >10 pRBC, increasing RBC:PC and RBC:FFP ratios were consistently associated with increased odds of 4h-mortality [38 ▪ ].…”

Section: Ratiomentioning

confidence: 99%

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Massive transfusion in trauma

Lier,

Hossfeld

2024

Current Opinion in Anaesthesiology

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Purpose of review The purpose of this review is to provide an overview of currently recommended treatment approaches for traumatic hemorrhage shock, with a special focus on massive transfusion. Recent findings Severe trauma patients require massive transfusion, but consensual international definitions for traumatic hemorrhage shock and massive transfusion are missing. Current literature defines a massive transfusion as transfusion of a minimum of 3–4 packed red blood cells within 1 h. Using standard laboratory and/or viscoelastic tests, earliest diagnosis and treatment should focus on trauma-induced coagulopathy and substitution of substantiated deficiencies. Summary To initiate therapy immediately massive transfusion protocols are helpful focusing on early hemorrhage control using hemostatic dressing and tourniquets, correction of metabolic derangements to decrease coagulopathy and substitution according to viscoelastic assays and blood gases analysis with tranexamic acid, fibrinogen concentrate, red blood cells, plasma and platelets are recommended. Alternatively, the use of whole blood is possible. If needed, further support using prothrombin complex, factor XIII or desmopressin is suggested.

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“…For HS: permissive hypotension; 15 mg/kg tranexamic acid; fibrinogen aiming at 2.2--2.5 g/l; PCC 25 >0.9 mmol/l [6 && ] and introduced the term "death diamond" [22]. Figure 1…”

Section: Key Pointsmentioning

confidence: 99%

“…Synthetic colloids should be avoided [16 ▪▪ ]. Contemporary strategies minimize balanced crystalloid use (“restrictive volume replacement strategy”) [16 ▪▪ ,25 ▪ ].…”

Section: Therapymentioning

confidence: 99%

Section: Plasmamentioning

confidence: 99%

Section: Plasmamentioning

confidence: 99%

Section: Ratiomentioning

confidence: 99%

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Massive transfusion in trauma

Lier,

Hossfeld

2024

Current Opinion in Anaesthesiology

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Evaluation of Tranexamic Acid and Calcium Chloride in Major Traumas in a Prehospital Setting: A Narrative Review

Bell

Salmon

Purdy

et al. 2023

Shock

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Excessive blood loss in the pre-hospital setting poses a significant challenge and is one of the leading causes of death in the United States. In response, emergency medical services (EMS) have increasingly adopted the use of tranexamic acid (TXA) and calcium chloride (CaCl2) as therapeutic interventions for hemorrhagic traumas. TXA functions by inhibiting plasmin formation and restoring hemostatic balance, while calcium plays a pivotal role in the coagulation cascade, facilitating the conversion of factor X to factor Xa and prothrombin to thrombin. Despite the growing utilization of TXA and CaCl2 in both pre-hospital and hospital environments, a lack of literature exists regarding the comparative effectiveness of these agents in reducing hemorrhage and improving patient outcomes. Notably, Morgan County Indiana EMS, recently integrated the administration of TXA with CaCl2 into their treatment protocols, offering a valuable opportunity to gather insight and formulate updated guidelines based on patient-centered outcomes. This narrative review aims to comprehensively evaluate the existing evidence concerning the administration of TXA and CaCl2 in the pre-hospital management of hemorrhages, while also incorporating and analyzing data derived from the co-administration of these medications within the practices of Morgan County EMS. This represents the inaugural description of the concurrent use of both TXA and CaCl2 to manage hemorrhages in the scientific literature.

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Evaluation of the efficacy and safety of lyophilized plasma

Dashkevich,

Bondaruk,

Fiadura

et al. 2024

jour

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Objective. To assess the hemostatic potential, preclinical safety and in vitro efficacy of lyophilized plasma in patients and blood donors.Materials and methods. The study of acute toxicity was carried out on outbred mice of both sexes (n=120), pyrogenicity – on rabbits of both sexes (n=30), abnormal toxicity – on mice (n=25) and guinea pigs (n=6). Histopathological studies were carried out on preparations of five fragments of the middle part of the mouse tail after intravenous administration of the maximum dose (4500 mg/kg) lyophilized plasma (LP), physiological solution, fresh frozen plasma (FFP) and pathogen-reduced FFP (PRFFP) using the Intercept system. The proand anticoagulant activity was investigated by clotting and chromogenic method to evaluate the hemostatic potential of PL. The effect on hemostasis was studied in vitro by thromboelastometry when FFP and LP were added to blood samples of patients (n = 23) and donors (n = 20). Results. Acute toxicity study showed the absence of death and clinical signs of intoxication in all series. On the 14th day, body weight gain was observed in animals of all series. Regardless of the used LP dosage, no development of effusion and adhesions in the thoracic and abdominal cavities, as well as macroscopically detectable pathologic changes of the main organs were observed in animals. The analysis of the relative weight of internal organs of animals did not reveal statistically significant differences in experimental and control series relative to the values of similar indicators in intact animals. The studied hemostatic potential showed that LP was not inferior to PRFFP in the content of coagulation factors of the blood system. Evaluation of the effect of LP application in vitro in female patients showed statistically significant correction of CT (clotting time) index, which indicates the effectiveness of its application for replenishment of blood coagulation factors (BCF).Conclusion. Preclinical animal studies of LP have proven its safety and efficacy compared to FFP.

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Transfusion Management in Trauma: What is Current Best Practice?

Cited by 3 publications

References 100 publications

Massive transfusion in trauma

Massive transfusion in trauma

Evaluation of Tranexamic Acid and Calcium Chloride in Major Traumas in a Prehospital Setting: A Narrative Review

Evaluation of the efficacy and safety of lyophilized plasma

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