Transfusion therapy in hemorrhagic shock

Abstract

Purpose of review Bleeding and death from hemorrhage remain a leading cause of morbidity and mortality in the trauma population. Early resuscitation of these gravely injured patients has changed significantly over the past several years. The concept of damage control resuscitation has expanded significantly with the experience of the US military in southwest Asia. This review will focus on this resuscitation strategy of transfusing blood products (red cells, plasma, and platelets) early and often in the exsanguinating patient. Recent findings In trauma there are no randomized controlled trials comparing the current damage control hematology concept to more traditional resuscitation methods. But the overwhelming conclusion of the data available support the administration of a high ratio of plasma and platelets to packed red blood cells. Several large retrospective studies have shown ratios close to 1 : 1 will result in higher survival. Summary The current evidence supports that the acute coagulopathy of trauma is present in a high percentage of trauma patients. Patients who will require a massive transfusion will have improved outcomes the earlier that this is identified and the earlier that damage control hematology is instituted. Current evidence does not describe the best ratio but the preponderance of the data suggests it should be greater than 2 : 3 plasma-to-packed red blood cells.

Hemorrhagic Shock in Polytrauma Patients: Early Detection with Renal Doppler Resistive Index Measurements

“…The patients with hemorrhagic shock also had a higher rate of intensive care unit admission (21 of 29 vs four of 23 patients, P , .01), ( 30 ). This is because even major occult bleeding may occur during the early phases after trauma without being recognized owing to the complex triage and screening procedures in overcrowded EDs.…”

The Importance of the Monitoring of Resuscitation With Blood Transfusion for Uterine Inversion in Obstetrical Hemorrhage

“…It has also been proposed that a delay in blood transfusion results in coagulopathy and organ failure [17]. Bonnet and colleagues reported that a delay in blood transfusion was associated with a series of maternal deaths from postpartum hemorrhage [18].…”

Patient Blood Management

“…Up to now, the administration of FFP has been reliant on trust in expert opinion alone. Despite this, large quantities of FFP (>15 ml/kg body weight) are recommended in cases of massive bleeding (Ho et al 2005 ;Gajic et al 2006 ;Spahn et al 2007 ;Theusinger et al 2009 ), given that a 1:1 ratio of plasma to RBCs is connected with a decreased mortality in massively transfused trauma patients (Nunez and Cotton 2009 ).…”