Hemorrhagic shock and hemostatic resuscitation in canine trauma

Trauma is one of the world's leading causes of death within the first 40 years of life and thus a significant health problem. Trauma accounts for nearly a third of the lost years of productive life before 65 years of age and is associated with infection, hemorrhagic shock, reperfusion syndrome, and inflammation. The control of hemorrhage, coagulopathy, optimal use of blood products, balancing hypo and hyperperfusion, and hemostatic resuscitation improve survival in cases of trauma with massive hemorrhage. This review discusses inflammation in the context of trauma-associated hemorrhagic shock. When one considers the known immunomodulatory effects of traumatic injury, allogeneic blood transfusion, and the overlap between patient populations, it is surprising that so few studies have assessed their combined effects on immune function. We also discuss the relative benefits of curbing inflammation rather than attempting to prevent it.

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Whole Blood for Blood Loss: Hemostatic Resuscitation in Damage Control

10.25100/cm.v51i4.4511 ◽

2020 ◽

Author(s):

Juan Carlos Salamea ◽

Amber Himmler ◽

Laura Isabel Valencia-Angel ◽

Carlos Alberto Ordoñez ◽

Michael Parra ◽

...

Keyword(s):

Hemorrhagic Shock ◽

Whole Blood ◽

Damage Control ◽

Fresh Frozen Plasma ◽

Trauma Patients ◽

Damage Control Resuscitation ◽

Middle Income ◽

Packed Red Blood Cells ◽

Hemostatic Resuscitation ◽

Fresh Frozen

Hemorrhagic shock and its complications are a major cause of death among trauma patients. The management of hemorrhagic shock using a damage control resuscitation strategy has been shown to decrease mortality and improve patient outcomes. One of the components of damage control resuscitation is hemostatic resuscitation, which involves the replacement of lost blood volume with components such as packed red blood cells, fresh frozen plasma, cryoprecipitate, and platelets in a 1:1:1:1 ratio. However, this is a strategy that is not applicable in many parts of Latin America and other low-and-middle-income countries throughout the world, where there is a lack of well-equipped blood banks and an insufficient availability of blood products. To overcome these barriers, we propose the use of cold fresh whole blood for hemostatic resuscitation in exsanguinating patients. Over 6 years of experience in Ecuador has shown that resuscitation with cold fresh whole blood has similar outcomes and a similar safety profile compared to resuscitation with hemocomponents. Whole blood confers many advantages over component therapy including, but not limited to the transfusion of blood with a physiologic ratio of components, ease of transport and transfusion, less volume of anticoagulants and additives transfused to the patient, and exposure to fewer donors. Whole blood is a tool with reemerging potential that can be implemented in civilian trauma centers with optimal results and less technical demand.

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Is the Whole Greater Than the Sum of Its Parts? The Implementation and Outcomes of a Whole Blood Program in Ecuador

10.21203/rs.3.rs-66244/v1 ◽

2020 ◽

Author(s):

Amber Nicole Himmler ◽

Monica Eulalia Galarza Armijos ◽

Jeovanni Reinoso Naranjo ◽

Sandra Gioconda Peña Patiño ◽

Doris Sarmiento Altamirano ◽

...

Keyword(s):

Latin America ◽

Hemorrhagic Shock ◽

Whole Blood ◽

Vital Signs ◽

Acute Care Surgery ◽

Transfusion Reaction ◽

Shock Index ◽

Middle Income ◽

Hemostatic Resuscitation ◽

Care Surgery

Abstract Background: Hemorrhagic shock is a major cause of mortality in low-and-middle-income countries (LMICs). Many institutions in LMICs lack the resources to adequately prescribe balanced resuscitation. This study aims to describe the implementation of a whole blood program in Latin America and discuss the outcomes of the patients that received whole blood (WB). Methods: We conducted a retrospective review of patients resuscitated with WB from 2013-2019. Five units of O+ WB were made available on a consistent basis for patients presenting in hemorrhagic shock. Variables collected included: sex, age, service treating the patient, units of WB administered, units of components administered, admission vital signs, admission hemoglobin, Shock Index, intraoperative crystalloid and colloid administration, symptoms of transfusion reaction, length-of-stay and in-hospital mortality.Results: The sample includes a total of 101 patients, 57 of whom were trauma and acute care surgery (TACS) patients and 44 of whom were obstetrics and gynecology patients. No patients developed symptoms consistent with a transfusion reaction. Average shock index was 1.16 (±0.55). On average, patients received 1.66 (±0.80) units of whole blood. Overall mortality was 14/101 (13.86%) in the first 24 hours and 6/101 (5.94%) after 24 hours.Conclusion: Implementing a WB protocol is achievable in LMICs. Whole blood allows for more efficient delivery of hemostatic resuscitation and is ideal for resource-restrained settings. To our knowledge, this is the first description of a whole blood program implemented in a civilian hospital in Latin America.

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Treatment of ebola and other infectious diseases: melatonin “goes viral”

Melatonin Research ◽

10.32794/mr11250047 ◽

2020 ◽

Vol 3 (1) ◽

pp. 43-57 ◽

Cited By ~ 21

Author(s):

Russel J Reiter ◽

Qiang Ma ◽

Ramaswamy Sharma

Keyword(s):

Mortality Rate ◽

Infectious Diseases ◽

Hemorrhagic Shock ◽

Safety Profile ◽

Ebola Virus ◽

Viral Infections ◽

Virus Disease ◽

Attractive Potential ◽

Potential Treatment

This review summarizes published reports on the utility of melatonin as a treatment for virus-mediated diseases. Of special note are the data related to the role of melatonin in influencing Ebola virus disease. This infection and deadly condition has no effective treatment and the published works documenting the ability of melatonin to attenuate the severity of viral infections generally and Ebola infection specifically are considered. The capacity of melatonin to prevent one of the major complications of an Ebola infection, i.e., the hemorrhagic shock syndrome, which often contributes to the high mortality rate, is noteworthy. Considering the high safety profile of melatonin, the fact that it is easily produced, inexpensive and can be self-administered makes it an attractive potential treatment for Ebola virus pathology.

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