Response to Wirtz et al: The impact of blood product ratio and procoagulant therapy on the development of thromboembolic events in severely injured hemorrhaging trauma patients

Transfusion ◽  
2021 ◽  
Vol 61 (3) ◽  
pp. 991-992
Author(s):  
Thorsten Haas ◽  
Jeannie Callum ◽  
Oliver Grottke ◽  
Lars M. Asmis ◽  
Melissa M. Cushing
Keyword(s):  
Blood Product ◽  
Trauma Patients ◽  
Severely Injured ◽  
Thromboembolic Events ◽  
Product Ratio ◽  
The Impact

scholarly journals The impact of blood product ratio and procoagulant therapy on the development of thromboembolic events in severely injured hemorrhaging trauma patients

Transfusion ◽  
2020 ◽  
Vol 60 (8) ◽  
pp. 1873-1882
Author(s):  
Mathijs R. Wirtz ◽  
Daisy V. Schalkers ◽  
J. Carel Goslings ◽  
Nicole P. Juffermans
Keyword(s):  
Blood Product ◽  
Trauma Patients ◽  
Severely Injured ◽  
Thromboembolic Events ◽  
Product Ratio ◽  
The Impact

scholarly journals Contemporary Transfusion Science and Challenges

2019 ◽  
Vol 30 (2) ◽  
pp. 139-150
Author(s):  
Heather M. Passerini
Keyword(s):  
Health Care ◽  
Health Care Professionals ◽  
Blood Product ◽  
Damage Control ◽  
Coagulation Factor ◽  
Trauma Patients ◽  
Transfusion Therapy ◽  
Use Of Resources ◽  
Study Results ◽  
The Impact

Health care professionals must understand the impact of blood product transfusions and transfusion therapy procedures to ensure high-quality patient care, positive outcomes, and wise use of resources in blood management programs. Understanding transfusions of blood and blood products is also important because of the number of treatments performed, which affects individual patients and health care system resources. This article reviews research findings to acquaint health care professionals with the most successful protocols for blood, blood product, and coagulation factor transfusions. Damage control resuscitation in bleeding trauma patients, protocols for patients without trauma who are undergoing surgical procedures that place them at risk for excessive bleeding, and protocols for patients with sepsis are addressed. Emerging research continues to help guide mass transfusion treatments (restrictive vs liberal, balanced, and goal-directed treatment). Although available study results provide some guidance, questions remain. Additional research by health care professionals is needed.

scholarly journals Health-Related Quality of Life in Severely Injured Trauma Patients with Positive and Negative Blood Alcohol Level on Admission

2020 ◽  
Author(s):  
Antti Riuttanen ◽  
Jarkko Jokihaara ◽  
Tuomas T. Huttunen ◽  
Ville M. Mattila
Keyword(s):  
Alcohol Use ◽  
Relative Number ◽  
Reference Population ◽  
Anxiety And Depression ◽  
Trauma Patients ◽  
Severely Injured ◽  
Post Injury ◽  
Related Quality ◽  
Negative Effect ◽  
The Impact

Abstract PurposeThe objectives of this study were to evaluate whether pre-injury alcohol use has an influence on an injured patient’s HR-QoL and reported problems.MethodsRetrospective analysis of 227 severely injured trauma patients (age ≥ 18 years, NISS ≥ 16) treated at Tampere University Hospital’s (TAUH) Intensive Care Unit (ICU) or High Dependence Unit (HDU) in 2013. HR-QoL was assessed with the EQ-5D questionnaire, and was further compared with index values of population norms of Finland.ResultsPatients with positive BAL expressed notably more anxiety and depression (45%) before trauma compared to both patients with negative BAL (11%) and the reference population (14%). Overall, pre-injury HR-QoL was also poorer in BAL positive patients than BAL negative patients. The amount of anxiety and depression in BAL positive patients decreased after injury. In both groups, the relative number of reported problems after injury exceeded the relative number of reported problems of the reference population in all five EQ-5D dimensions.ConclusionsPatients with positive BAL upon admission report overall lower pre-injury HR-QoL than patients with negative BAL, which is most likely explained by the alcohol’s negative effect on mental health. As reported anxiety and depression decreased one year after injury, we speculate that this may partly be explained by a possible reduction in alcohol use, which has been reported to happen in injury patients. As has previously been reported, the impact of severe injury on post-injury QoL in general is detrimental and long-lasting and overall HR-QoL remains lower than the population norm.

scholarly journals Prospective evaluation of admission cortisol in trauma

2020 ◽  
Vol 5 (1) ◽  
pp. e000386
Author(s):  
Amy M Kwok ◽  
James W Davis ◽  
Rachel C Dirks ◽  
Lawrence P Sue ◽  
Mary M Wolfe ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Cortisol Level ◽  
Blood Product ◽  
Total Serum ◽  
Trauma Patients ◽  
Blood Draw ◽  
Cortisol Levels ◽  
Low Cortisol ◽  
Vasopressor Use ◽  
The Impact

BackgroundA low cortisol level has been shown to occur soon after trauma, and is associated with increased mortality. The purpose of this study was to investigate the impact of low cortisol levels in acute critically ill trauma patients. We hypothesized that patients would require increase vasopressor use, have a greater blood product administration, and increased mortality rate.MethodsA blinded, prospective observational study was performed at an American College of Surgeons verified Level I trauma center. Adult patients who met trauma activation criteria, received initial treatment at Community Regional Medical Center and were admitted to the intensive care unit were included. Total serum cortisol levels were measured from the initial blood draw in the emergency department. Patients were categorized according to cortisol ≤15 µg/dL (severe low cortisol, SLC), 15.01–25 µg/dL (relative low cortisol, RLC), or >25 µg/dL (normal cortisol, NC) and compared on demographics, injury severity score, initial vital signs, blood product usage, vasopressor requirements, and mortality.ResultsCortisol levels were ordered for 280 patients; 91 were excluded and 189 were included. Penetrating trauma accounted for 19% of injuries and blunt trauma for 81%. 22 patients (12%) had SLC, 83 (44%) had RLC, and 84 (44%) had NC. This study found patients with admission SLC had higher rates of vasopressor requirements, required more units of blood, and had a higher mortality rate than both the RLC and NC groups.ConclusionLow cortisol level can be identified acutely after severe trauma. Trauma patients with SLC had larger blood product requirements, vasopressor use, and increase mortality. Initial cortisol levels are useful in identifying these high-risk patients.Level of evidencePrognostic/epidemiologic study, level III

1561: MORTALITY FOLLOWING HIGH BLOOD PRODUCT TRANSFUSION AMONG SEVERELY INJURED TRAUMA PATIENTS

2016 ◽  
Vol 44 (12) ◽  
pp. 465-465
Author(s):  
Christopher Wybourn ◽  
April Mendoza ◽  
Mitchell Cohen ◽  
Rachael Callcut
Keyword(s):  
Blood Product ◽  
Blood Product Transfusion ◽  
Trauma Patients ◽  
Severely Injured

Reducing Mortality Among Bleeding Trauma Patients with Tranexamic Acid

2018 ◽  
pp. 241-247
Author(s):  
Haytham M. A. Kaafarani
Keyword(s):  
Randomized Controlled Trial ◽  
Tranexamic Acid ◽  
Hemorrhagic Shock ◽  
Low Income ◽  
Controlled Trial ◽  
Low Income Countries ◽  
Trauma Patients ◽  
Thromboembolic Events ◽  
The World ◽  
The Impact

The CRASH-2 trial is a randomized controlled trial performed in more than 270 hospitals across the world and aimed at studying the impact of tranexamic acid (TXA), an anti-fibrinolytic agent, on mortality in trauma patients presenting with hemorrhagic shock. With more than 20,000 patients, CRASH-2 showed a small but statistically significant decrease in mortality from 16% to 14.5% (p < 0.05), without any increase in thromboembolic events, in patients who received TXA versus placebo. Subset analyses suggested that the benefit was only present if TXA was administered within 3 h from injury. Two main criticisms of the study are (1) TXA reduced mortality but not the number of blood products used or the percentage of patients who needed transfusion, raising questions regarding the mechanism by which the drug worked; (2) the conductance of the study in moderate- to low-income countries, limiting its generalizability to high-income countries with advanced trauma systems.

The impact of blood product ratios in massively transfused pediatric trauma patients

2013 ◽  
Vol 206 (5) ◽  
pp. 655-660 ◽  
Author(s):  
Lauren Nosanov ◽  
Kenji Inaba ◽  
Obi Okoye ◽  
Shelby Resnick ◽  
Jeffrey Upperman ◽  
...  
Keyword(s):  
Blood Product ◽  
Pediatric Trauma ◽  
Trauma Patients ◽  
The Impact

Assessing the influence of non-treatment variables in a study of outcome from severe head injuries

1984 ◽  
Vol 61 (2) ◽  
pp. 254-262 ◽  
Author(s):  
A. Russell Lokkeberg ◽  
Richard M. Grimes
Keyword(s):  
Regression Analysis ◽  
Analysis Of Variance ◽  
Head Injuries ◽  
Trauma Patients ◽  
Severely Injured ◽  
Content Type ◽  
Severity Of Injury ◽  
Mode Of Transportation ◽  
The Impact ◽  
Fine Print

✓ An evaluation was made of the impact of non-treatment variables on severely injured head trauma patients. The principal findings were: 1) severity of injury was the best predictor of outcome; 2) patient's age had a statistically significant but marginally useful impact on outcome; 3) a regression analysis showed that duration of transport, up to 4 hours, had no impact on outcome; 4) time from accident to intubation had a marginal impact on outcome; and 5) one-way analysis of variance showed that mode of transportation, whether helicopter, ambulance, or other means had no impact on outcome.

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