Prehospital Plasma Transfusion: What Does the Literature Show?

Background: Early initiation of blood products transfusion after injury has been associated with improved patient outcomes following traumatic injury. The ability to transfuse patients’ plasma in the prehospital setting provides a prime opportunity to begin resuscitation with blood products earlier and with a more balanced plasma:RBC ratio than what has traditionally been done. Published studies on the use of prehospital plasma show a complex relationship between its use and improved survival. Summary: Examination of the literature shows that there may be a mortality benefit from the use of prehospital plasma, but that it may be limited to certain subgroups of trauma patients. The likelihood of realizing these survival benefits appears to be predicted by several factors including the type of injury, length of transport time, presence of traumatic brain injury, and total number of blood products transfused, whether the patient required only a few products or a massive transfusion. When taken as a whole the evidence appears to show that prehospital plasma may have a mortality benefit that is most clearly demonstrated in patients with blunt injuries, moderate transfusion requirements, traumatic brain injury, and/or transport time greater than 20 min, as well as those who demonstrate a certain cytokine expression profile. Key Messages: The evidence suggests that a targeted use of prehospital plasma will most likely maximize the benefits from the use of this limited resource. It is also possible that prehospital plasma may best be provided through whole blood as survival benefits were greatest in patients who received both prehospital plasma and RBCs.

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Initial free cortisol dynamics following blunt multiple trauma and traumatic brain injury: A clinical study

Journal of International Medical Research ◽

10.1177/0300060518819603 ◽

2019 ◽

Vol 47 (3) ◽

pp. 1185-1194

Author(s):

T Kusmenkov ◽

M Braunstein ◽

HJ Schneider ◽

M Bidlingmaier ◽

WC Prall ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Multiple Trauma ◽

Repeated Measures ◽

Traumatic Injury ◽

Trauma Centre ◽

Trauma Patients ◽

Total Cortisol ◽

Free Cortisol ◽

Multiple Trauma Patients

Objective To determine free and total cortisol serum concentrations in the first 24 h after trauma and to evaluate the influence of traumatic brain injury (TBI) on their dynamics. Methods This prospective cohort study enrolled patients who had experienced multiple trauma and were admitted to a level 1 trauma centre. The patients were divided in two groups based on the presence of TBI according to clinical and radiological findings. Blood was collected initially as well as at 12 h and 24 h after the traumatic injury. Total cortisol, corticosteroid binding globulin (CBG) and free cortisol levels were determined. Results The study analysed data from 49 patients (36 males and 13 females) with a mean ± SD age of 45.0 ± 16.0 years. Of these, 36 presented with TBI and 13 had multiple injuries without TBI. Patients with TBI showed significantly lower concentrations of total cortisol and free cortisol compared with patients without TBI. Repeated measures analysis revealed different concentration dynamics in patients with TBI, with no increase in cortisol after trauma. Conclusion Multiple trauma patients with TBI are at risk of acute impaired cortisol secretion and show an attenuated stress response as early as 12 h after injury.

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Degree of Anticoagulation, but Not Warfarin Use Itself, Predicts Adverse Outcomes After Traumatic Brain Injury in Elderly Trauma Patients

Journal of Trauma and Acute Care Surgery ◽

10.1097/ta.0b013e31812e5216 ◽

2007 ◽

Vol 63 (3) ◽

pp. 525-530 ◽

Cited By ~ 94

Author(s):

Fredric M. Pieracci ◽

Soumitra R. Eachempati ◽

Jian Shou ◽

Lynn J. Hydo ◽

Philip S. Barie

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Adverse Outcomes ◽

Trauma Patients ◽

Elderly Trauma Patients

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Prehospital resuscitation

Trauma Surgery & Acute Care Open ◽

10.1136/tsaco-2021-000729 ◽

2021 ◽

Vol 6 (1) ◽

pp. e000729

Author(s):

Alexandra M P Brito ◽

Martin Schreiber

Keyword(s):

Young People ◽

Tranexamic Acid ◽

New Technologies ◽

Blood Product ◽

Traumatic Injury ◽

Trauma Patients ◽

Blood Products ◽

Front Line ◽

The Usa ◽

Review Current

Traumatic injury is the leading cause of death in young people in the USA. Our knowledge of prehospital resuscitation is constantly evolving and is often informed by research based on military experience. A move toward balanced blood product resuscitation and away from excessive crystalloid use has led to improvements in outcomes for trauma patients. This has been facilitated by new technologies allowing more front-line use of blood products as well as use of tranexamic acid in the prehospital setting. In this article, we review current practices in prehospital resuscitation and the studies that have informed these practices.

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Management of Traumatic Brain Injury: A review Update

Journal of Shaheed Suhrawardy Medical College ◽

10.3329/jssmc.v6i2.31777 ◽

2017 ◽

Vol 6 (2) ◽

pp. 87-89

Author(s):

ATM Ashadullah ◽

Monirul Islam ◽

Fazley Elahi Milad ◽

Abdullah Alamgir ◽

Md Shafiul Alam

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Head Injuries ◽

Skull Fracture ◽

Traumatic Injury ◽

Loss Of Consciousness ◽

Extradural Haematoma ◽

Inner Surface ◽

Injury Patient ◽

Extradural Haematomas

Traumatic Brain Injury leads to serious consequences. Approximately half of all deaths is related to traumatic injury and the main cause of head trauma. Extradural haematomas (EDH) develops in all major head injuries. A head injury patient who is only temporary loss of consciousness and is left asleep may sometimes be found dead in the bed next morning due to extradural haematoma. Extradural haematoma which lies in between the inner surface of skull and stripes of dural membrane, are nearly always caused by, and located near a skull fracture. The collection takes several forms in terms of size, location, speed of development and effects they exert on patient. Immediate management is necessary to decrease the bad consequences. In this review the management of traumatic brain injury is highlighted.J Shaheed Suhrawardy Med Coll, 2014; 6(2):87-89

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Traumatic Brain Injury Caused by Motor Vehicle Collision and Alcoholism in Piauí

Arquivos Brasileiros de Neurocirurgia Brazilian Neurosurgery ◽

10.1055/s-0036-1583935 ◽

2016 ◽

Vol 37 (03) ◽

pp. 174-181

Author(s):

Benjamim Vale ◽

Juçara Castro ◽

Marx Araújo ◽

Herb Morais ◽

Lívio Macêdo

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Motor Vehicle ◽

Care Service ◽

Diffuse Axonal Injury ◽

Total Sample ◽

Motor Vehicle Collision ◽

Alcoholic Beverages ◽

Trauma Patients ◽

Vehicle Collision

Objectives To determine the relationship between alcohol consumption and the incidence of traumatic brain injury (TBI) with diffuse axonal injury (DAI), determining these indices, checking acquired comorbidities and characterizing the patients by gender, age and race/color, as well as describing the characteristics of the motor vehicle collision (vehicle, period of the day, day of the week and site) in people admitted to an emergency hospital in the city of Teresina, in the state of Piauí, Brazil. Methods We have analyzed the data contained in the medical records of patients admitted with a history of motor vehicle collision and severe TBI in intensive care units, based on the forms provided by the Mobile Emergency Care Service (SAMU, in the Portuguese acronym) in the period between February 28 and November 28, 2013. Results In the period covered by the present study, 200 individuals were analyzed, and 54 (27%) had consumed alcohol; of these 11 had DAI. Of the total sample, 17% (34) presented DAI, however, with unknown data regarding the consumption of alcoholic beverages. Conclusion Considering the data, we observed that the profile of the head trauma patients are brown men, mostly (53.5%) aged between 15 and 30 years. The collisions occurred mostly on weekends and at night (55%), and 89.5% of the crashes involved motorcycles.

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Trauma

Congress of Neurological Surgeons Essent ◽

10.1093/med/9780197534342.003.0005 ◽

2020 ◽

pp. 131-170

Keyword(s):

Traumatic Brain Injury ◽

Spinal Cord ◽

Spinal Cord Injury ◽

Brain Injury ◽

Severe Traumatic Brain Injury ◽

Brain Injuries ◽

Cervical Spinal Cord ◽

Trauma Patients ◽

Cervical Spine Injuries ◽

Cord Injury

This chapter discusses traumatic spinal cord and brain injuries. The first three studies review the background and key findings of the third National Acute Spinal Cord Injury Study (NASCIS) trial, examine the efficacy of the Canadian C-Spine Rule in the evaluation of cervical spine injuries in alert and stable trauma patients; and describe the development of the Thoracolumbar Injury Classification and Severity Score (TLICS) classification system. The next two studies assess the effect of early surgical decompression in patients with traumatic cervical spinal cord injury and delineate the role of secondary brain injury in determining patient outcome in severe traumatic brain injury. The following set of four studies evaluates the efficacy of phenytoin in preventing posttraumatic seizures, as well as the efficacy of intracranial pressure monitoring, induction of hypothermia, and decompressive craniectomy for severe traumatic brain injury. The last study, which is of historical value, identifies predictors of outcome in comatose patients with traumatic acute subdural hematoma.

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The Impact of Accidental Hypothermia on Mortality in Trauma Patients Overall and Patients with Traumatic Brain Injury Specifically: A Systematic Review and Meta-Analysis

World Journal of Surgery ◽

10.1007/s00268-020-05750-5 ◽

2020 ◽

Vol 44 (12) ◽

pp. 4106-4117

Author(s):

David Rösli ◽

Beat Schnüriger ◽

Daniel Candinas ◽

Tobias Haltmeier

Keyword(s):

Systematic Review ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Hospital Mortality ◽

Meta Analysis ◽

Accidental Hypothermia ◽

Trauma Patients ◽

Qualitative Synthesis ◽

Pubmed Database ◽

The Impact

Abstract Background Accidental hypothermia is a known predictor for worse outcomes in trauma patients, but has not been comprehensively assessed in a meta-analysis so far. The aim of this systematic review and meta-analysis was to investigate the impact of accidental hypothermia on mortality in trauma patients overall and patients with traumatic brain injury (TBI) specifically. Methods This is a systematic review and meta-analysis using the Ovid Medline/PubMed database. Scientific articles reporting accidental hypothermia and its impact on outcomes in trauma patients were included in qualitative synthesis. Studies that compared the effect of hypothermia vs. normothermia at hospital admission on in-hospital mortality were included in two meta-analyses on (1) trauma patients overall and (2) patients with TBI specifically. Meta-analysis was performed using a Mantel–Haenszel random-effects model. Results Literature search revealed 264 articles. Of these, 14 studies published 1987–2018 were included in the qualitative synthesis. Seven studies qualified for meta-analysis on trauma patients overall and three studies for meta-analysis on patients with TBI specifically. Accidental hypothermia at admission was associated with significantly higher mortality both in trauma patients overall (OR 5.18 [95% CI 2.61–10.28]) and patients with TBI specifically (OR 2.38 [95% CI 1.53–3.69]). Conclusions In the current meta-analysis, accidental hypothermia was strongly associated with higher in-hospital mortality both in trauma patients overall and patients with TBI specifically. These findings underscore the importance of measures to avoid accidental hypothermia in the prehospital care of trauma patients.

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Early versus Late Tracheostomy: Is There an Outcome Difference?

The American Surgeon ◽

10.1177/000313481908500427 ◽

2019 ◽

Vol 85 (4) ◽

pp. 370-375 ◽

Cited By ~ 7

Author(s):

Adel Elkbuli ◽

Raed Ismail Narvel ◽

Paul J. Spano ◽

Valerie Polcz ◽

Astrid Casin ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Glasgow Coma Scale ◽

Primary Outcome ◽

Injury Severity ◽

Future Research ◽

Trauma Patients ◽

Early Tracheostomy ◽

Outcome Difference ◽

The Impact

The effect of timing in patients requiring tracheostomy varies in the literature. The purpose of this study was to evaluate the impact of early tracheostomy on outcomes in trauma patients with and without traumatic brain injury (TBI). This study is a four-year review of trauma patients undergoing tracheostomy. Patients were divided into two groups based on TBI/non-TBI. Each group was divided into three subgroups based on tracheostomy timing: zero to three days, four to seven days, and greater than seven days postadmission. TBI patients were stratified by the Glasgow Coma Scale (GCS), and non-TBI patients were stratified by the Injury Severity Score (ISS). The primary outcome was ventilator-free days (VFDs). Significance was defined as P < 0.05. Two hundred eighty-nine trauma patients met the study criteria: 151 had TBI (55.2%) versus 138 (47.8%) non-TBI. There were no significant differences in demographics within and between groups. In TBI patients, statistically significant increases in VFDs were observed with GCS 13 to 15 for tracheostomies performed in four to seven versus greater than seven days ( P = 0.005). For GCS <8 and 8 to 12, there were significant increases in VFDs for tracheostomies performed at days 1 to 3 and 4 to 7 versus greater than seven days (P << 0.05 for both). For non-TBI tracheostomies, only ISS ≥ 25 with tracheostomies performed at zero to three days versus greater than seven days was associated with improved VFDs. Early tracheostomies in TBI patients were associated with improved VFDs. In trauma patients with no TBI, early tracheostomy was associated with improved VFDs only in patients with ISS ≥ 25. Future research studies should investigate reasons TBI and non-TBI patients may differ.

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