scholarly journals What's new for trauma haemorrhage management?

2019 ◽  
Vol 80 (5) ◽  
pp. 268-273
Author(s):  
Paul Vulliamy ◽  
Anthony J Thaventhiran ◽  
Ross A Davenport
Keyword(s):  
Blood Product ◽  
Global Burden ◽  
Blood Product Transfusion ◽  
Trauma Patients ◽  
Major Contributor ◽  
Early Administration ◽  
Haemorrhage Control ◽  
Treatment Priority ◽  
Active Research ◽  
Radiological Intervention

Uncontrolled haemorrhage is the leading cause of preventable death from injury and is a major contributor to the global burden of disease. The majority of deaths resulting from bleeding occur within the first 3 hours of hospital admission, and the window for meaningful intervention is therefore extremely small. Resuscitative efforts during active bleeding should focus on maintaining haemostatic function with blood product transfusion and early administration of tranexamic acid. Achieving control of haemorrhage is the overarching treatment priority and may require temporising measures before definitive surgical or radiological intervention. This review summarizes the contemporary approaches to resuscitation of bleeding trauma patients, options for achieving haemorrhage control, and current areas of active research including organ protective resuscitation and suspended animation.

Prehospital Blood Product Administration Opportunities in Ground Transport ALS EMS – A Descriptive Study

2018 ◽  
Vol 33 (3) ◽  
pp. 230-236 ◽  
Author(s):  
Felicia M. Mix ◽  
Martin D. Zielinski ◽  
Lucas A. Myers ◽  
Kathy S. Berns ◽  
Anurahda Luke ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Patient Care ◽  
Blood Product ◽  
Life Support ◽  
Descriptive Study ◽  
Blood Product Transfusion ◽  
Trauma Patients ◽  
Blood Products ◽  
Total Patient ◽  
Significant Difference

AbstractIntroductionHemorrhage remains the major cause of preventable death after trauma. Recent data suggest that earlier blood product administration may improve outcomes. The purpose of this study was to determine whether opportunities exist for blood product transfusion by ground Emergency Medical Services (EMS).MethodsThis was a single EMS agency retrospective study of ground and helicopter responses from January 1, 2011 through December 31, 2015 for adult trauma patients transported from the scene of injury who met predetermined hemodynamic (HD) parameters for potential transfusion (heart rate [HR]≥120 and/or systolic blood pressure [SBP]≤90).ResultsA total of 7,900 scene trauma ground transports occurred during the study period. Of 420 patients meeting HD criteria for transfusion, 53 (12.6%) had a significant mechanism of injury (MOI). Outcome data were available for 51 patients; 17 received blood products during their emergency department (ED) resuscitation. The percentage of patients receiving blood products based upon HD criteria ranged from 1.0% (HR) to 5.9% (SBP) to 38.1% (HR+SBP). In all, 74 Helicopter EMS (HEMS) transports met HD criteria for blood transfusion, of which, 28 patients received prehospital blood transfusion. Statistically significant total patient care time differences were noted for both the HR and the SBP cohorts, with HEMS having longer time intervals; no statistically significant difference in mean total patient care time was noted in the HR+SBP cohort.ConclusionsIn this study population, HD parameters alone did not predict need for ED blood product administration. Despite longer transport times, only one-third of HEMS patients meeting HD criteria for blood administration received prehospital transfusion. While one-third of ground Advanced Life Support (ALS) transport patients manifesting HD compromise received blood products in the ED, this represented 0.2% of total trauma transports over the study period. Given complex logistical issues involved in prehospital blood product administration, opportunities for ground administration appear limited within the described system.MixFM, ZielinskiMD, MyersLA, BernsKS, LukeA, StubbsJR, ZietlowSP, JenkinsDH, SztajnkrycerMD. Prehospital blood product administration opportunities in ground transport ALS EMS – a descriptive study. Prehosp Disaster Med. 2018;33(3):230–236.

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

Outcome Analysis of Blood Product Transfusion in Trauma Patients: A Prospective, Risk-Adjusted Study

2008 ◽  
Vol 32 (10) ◽  
Author(s):  
Grant V. Bochicchio ◽  
Lena Napolitano ◽  
Manjari Joshi ◽  
Kelly Bochicchio ◽  
Walter Meyer ◽  
...  
Keyword(s):  
Blood Product ◽  
Outcome Analysis ◽  
Blood Product Transfusion ◽  
Trauma Patients ◽  
Prospective Risk

Blood Product Transfusion and Ventilator-Associated Pneumonia in Trauma Patients

2008 ◽  
Vol 9 (4) ◽  
pp. 415-422 ◽  
Author(s):  
Grant V. Bochicchio ◽  
Lena Napolitano ◽  
Manjari Joshi ◽  
Kelly Bochicchio ◽  
Diane Shih ◽  
...  
Keyword(s):  
Blood Product ◽  
Blood Product Transfusion ◽  
Trauma Patients ◽  
Ventilator Associated Pneumonia

Point-of-Care Coagulation Monitoring in Trauma Patients

2017 ◽  
Vol 43 (04) ◽  
pp. 367-374 ◽  
Author(s):  
Philipp Stein ◽  
Alexander Kaserer ◽  
Gabriela Spahn ◽  
Donat Spahn
Keyword(s):  
Blood Product ◽  
Point Of Care ◽  
Fixed Ratio ◽  
Allogeneic Blood ◽  
Blood Product Transfusion ◽  
Trauma Patients ◽  
Coagulation Management ◽  
Trauma Induced Coagulopathy ◽  
Trauma Patient Outcome ◽  
Factor Concentrate

AbstractTrauma remains one of the major causes of death and disability all over the world. Uncontrolled blood loss and trauma-induced coagulopathy represent preventable causes of trauma-related morbidity and mortality. Treatment may consist of allogeneic blood product transfusion at a fixed ratio or in an individualized goal-directed way based on point-of-care (POC) and routine laboratory measurements. Viscoelastic POC measurement of the developing clot in whole blood and POC platelet function testing allow rapid and tailored coagulation and transfusion treatment based on goal-directed, factor concentrate–based algorithms. The first studies have been published showing that this concept reduces the need for allogeneic blood transfusion and improves outcome. This review highlights the concept of goal-directed POC coagulation management in trauma patients, introduces a selection of POC devices, and presents algorithms which allow a reduction in allogeneic blood product transfusion and an improvement of trauma patient outcome.

scholarly journals African American race, obesity, and blood product transfusion are risk factors for acute kidney injury in critically ill trauma patients

2012 ◽  
Vol 27 (5) ◽  
pp. 496-504 ◽  
Author(s):  
Michael G.S. Shashaty ◽  
Nuala J. Meyer ◽  
A. Russell Localio ◽  
Robert Gallop ◽  
Scarlett L. Bellamy ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
African American ◽  
Critically Ill ◽  
Blood Product ◽  
Kidney Injury ◽  
Blood Product Transfusion ◽  
Trauma Patients ◽  
African American Race

scholarly journals The Effects of Oral Anticoagulant Exposure on the Surgical Outcomes of Patients Undergoing Surgery for High-Risk Abdominal Emergencies

2021 ◽  
Author(s):  
Woubet Tefera Kassahun ◽  
Tristan Cedric Wagner ◽  
Jonas Babel ◽  
Matthias Mehdorn
Keyword(s):  
Liver Cirrhosis ◽  
High Risk ◽  
Hospital Mortality ◽  
Oral Anticoagulant ◽  
Blood Product ◽  
Oral Anticoagulants ◽  
Blood Product Transfusion ◽  
Bleeding Rate ◽  
Abdominal Emergencies ◽  
Peripheral Arterial

Abstract Background In chronic anticoagulant users undergoing surgery, bleeding and thromboembolism are common and serious complications. Many studies on mainly elective or minor emergency surgical procedures with low associated risks have focused on these outcomes. In comparison, patients undergoing high-risk emergency abdominal surgical procedures have not received sufficient attention. This study aimed to compare outcomes between oral anticoagulant users and nonusers who required emergency laparotomy for high-risk abdominal emergencies. Methods Patients who underwent surgery for abdominal emergencies at our institution between January 2012 and July 2019 were retrospectively reviewed. Results There were 875 patients, including 370 anticoagulant users and 505 nonusers. Of the 370 anticoagulant users, 189 (51.3), 77 (20.8%), 45 (12.2%), and 59 (15.9%) were prescribed antiplatelets, a vitamin k antagonist, a direct oral anticoagulant, and a combination drug regimen, respectively. The most common high-risk emergencies requiring surgery in both groups were perforated viscus (25.7% vs 40.9%), mesenteric ischemia with enteric necrosis (27% vs 12.8%), and bowel obstruction (17.6% vs 28.1%). The overall bleeding rate was higher (29.2% vs 22%, p = 0.015) in anticoagulant users than in nonusers, but the major bleeding rate was similar (17.8% vs 14.1%, p = 0.129) between the two groups. The rates of thromboembolic events and mortality were significantly higher in anticoagulant users than in nonusers (25.7% vs 9.7%, p < 0.0001 and 39.7% vs 31.1%, p = 0.01, respectively). Liver cirrhosis, peripheral arterial diseases, reoperation, and blood product transfusion were independent predictors of the overall risk of bleeding or TEEs, according to the multivariate analysis. In this model, liver cirrhosis had the largest overall effect on mortality, followed by pneumonia, thromboembolism, peripheral arterial disease, blood product transfusion, and atrial fibrillation. The use of oral anticoagulants was not an independent predictor of either bleeding or in-hospital mortality. The use of oral anticoagulants was associated with a decreased risk of all-cause in-hospital mortality. Conclusion Based on our results, the continued use of oral anticoagulants is more protective than harmful considering the overall outcomes in this subset of patients.

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