scholarly journals Comparing hemostatic resuscitation management of intraoperative massive bleeding with traumatic massive bleeding: a computer simulation

2020 ◽  
Vol 15 (4) ◽  
pp. 459-465
Author(s):  
Young Sun Lee ◽  
Kyu Nam Kim ◽  
Min Kyu Lee ◽  
Jung Eun Sun ◽  
Hyun Jin Lim ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Loss ◽  
Fresh Frozen Plasma ◽  
Massive Bleeding ◽  
Blood Component ◽  
Trauma Patients ◽  
Intraoperative Bleeding ◽  
Packed Red Blood Cells ◽  
Hemostatic Resuscitation ◽  
Traumatic Bleeding

Background: Appropriate blood component transfusion might differ between intraoperative massive bleeding and traumatic massive bleeding in the emergency department because trauma patients initially bleed undiluted blood and replacement typically lags behind blood loss. We compared these two blood loss scenarios, intraoperative and traumatic, using a computer simulation.Methods: We modified the multi-compartment dynamic model developed by Hirshberg and implemented it using STELLA 9.0. In this model, blood pressure changes as blood volume fluctuates as bleeding rate and transcapillary refill rate are controlled by blood pressure. Using this simulation, we compared the intraoperative bleeding scenario with the traumatic bleeding scenario. In both scenarios, patients started to bleed at a rate of 50 ml/min. In the intraoperative bleeding scenario, fluid was administered to maintain isovolemic status; however, in the traumatic bleeding scenario, no fluid was supplied for up to 30 min and no blood was supplied for up to 50 min. Each unit of packed red blood cells (PRBC) was given when the hematocrit decreased to 27%, fresh frozen plasma (FFP) was transfused when plasma was diluted to 30%, and platelet concentrate (PC) was transfused when platelet count became 50,000/ml.Results: In both scenarios, the appropriate ratio of PRBC:FFP was 1:0.47 before PC transfusion, and the ratio of PRBC:FFP:platelets was 1:0.35:0.39 after initiation of PC transfusion.Conclusion: The ratio of transfused blood component did not differ between the intraoperative bleeding and traumatic bleeding scenarios.

A 0.6-protamine/heparin ratio in cardiac surgery is associated with decreased transfusion of blood products

2020 ◽  
Vol 31 (3) ◽  
pp. 391-397
Author(s):  
Anne L M Goedhart ◽  
Bastiaan M Gerritse ◽  
Thijs C D Rettig ◽  
Martijn W A van Geldorp ◽  
Sander Bramer ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Blood Loss ◽  
Thrombus Formation ◽  
Group Versus ◽  
Fresh Frozen Plasma ◽  
Interquartile Range ◽  
Postoperative Blood Loss ◽  
Blood Component ◽  
Packed Red Blood Cells ◽  
Blood Component Transfusion

Abstract OBJECTIVES In cardiac surgery, adequate heparinization is necessary to prevent thrombus formation in the cardiopulmonary bypass (CPB). To counteract the heparin effect after weaning from CPB, protamine is administered. The optimal protamine/heparin ratio is still unknown. METHODS In this before–after study, we evaluated the effect of a 0.6/1-protamine/heparin ratio implementation as of May 2017 versus a 0.8/1-protamine/heparin ratio on the 12-h postoperative blood loss and the amount of blood and blood component transfusions (fresh frozen plasma, packed red blood cells, fibrinogen concentrate, platelet concentrate and prothrombin complex concentrate) after cardiac surgery. A total of 2051 patients who underwent cardiac surgery requiring CPB between May 2016 and May 2018 were included. RESULTS In the 0.6/1-protamine/heparin ratio group, only 28.8% of the patients received blood component transfusion, compared to 37.9% of the patients in the 0.8/1-ratio group (P < 0.001). The median 12-h postoperative blood loss was 230 ml (interquartile range 140–320) in the 0.6/1-ratio group versus 260 ml (interquartile range 155–365) in the 0.8/1-ratio group (P < 0.001). CONCLUSIONS A 0.6/1-protamine/heparin ratio after weaning from CPB is associated with a significantly reduced 12-h postoperative blood loss and blood components transfusion.

scholarly journals Whole Blood for Blood Loss: Hemostatic Resuscitation in Damage Control

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.

scholarly journals A Prospective Randomized Clinical Trial of Efficacy of Algorithm-Based Point of Care Guided Hemostatic Therapy in Cyanotic Congenital Heart Disease Surgical Patients

2019 ◽  
Vol 03 (01) ◽  
pp. 08-16
Author(s):  
Ameya Karanjkar ◽  
Poonam Malhotra Kapoor ◽  
Sandeep Sharan ◽  
Vandana Bhardwaj ◽  
Vishwas Malik ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Point Of Care ◽  
Fresh Frozen Plasma ◽  
Surgical Patients ◽  
Blood Component ◽  
Chest Drain ◽  
Packed Red Blood Cells ◽  
Mechanical Ventilation Duration ◽  
Blood Component Therapy ◽  
Hemostatic Therapy

Abstract Objective Point of care (POC) testing-based algorithm-guided hemostatic therapy has been used in adult as well as pediatric cardiac surgical patients to administer blood components. The authors hypothesized that implementation of POC-based algorithm in pediatric cyanotic congenital surgical patients would reduce the exposure to blood component therapy and improve the clinical outcome. Design Prospective randomized control trial. Setting Single-center academic institute. Participants One hundred seventy pediatric congenital cyanotic surgical patients. Intervention Implementation of POC and conventional tests-based algorithms. Measurements and Main Results Algorithm-based blood component therapy was administered in each group. There were no group differences regarding the demographic, clinical, and laboratory characteristics. Amount of packed red blood cells (PRBCs), fresh frozen plasma (FFP), platelets, and cryoprecipitate (primary outcomes) administered was significantly lower in POC group than that in the conventional group (p < 0.001). Among the secondary outcomes, the chest drain output at 6, 12, and 24 hours and number of re-explorations was comparable among both the groups. The duration of mechanical ventilation, duration of intensive care unit (ICU) stay, and hospital stay was significantly short in POC group (p = 0.008, <0.001 and 0.019, respectively). Conclusion Implementation of POC-based algorithm-guided hemostatic therapy reduced the exposure to blood and blood component therapy and was associated with reduced ICU and hospital stay in pediatric congenital cyanotic surgical patients.

scholarly journals Blood Component Therapy

2018 ◽  
Vol 9 (2) ◽  
pp. 142-147
Author(s):  
Shanaz Karim ◽  
Ehteshamul Hoque ◽  
Md Mazharul Hoque ◽  
Syeda Masooma Rahman ◽  
Kashfia Islam
Keyword(s):  
Red Blood Cells ◽  
Whole Blood ◽  
Blood Cells ◽  
Fresh Frozen Plasma ◽  
Blood Component ◽  
Packed Red Blood Cells ◽  
Medical College ◽  
Blood Component Therapy ◽  
Fresh Frozen ◽  
Cellular Components

Transfusion medicine has undergone advancements since its initiation in the early 20th century. One of these was the discovery that blood can be divided into individual components and delivered separately. Today, blood transfusions nearly always consist of the ad-ministration of 1 or more components of blood. Whole blood transfusion is now limited to situations involving massive resuscitation (trauma ) The most familiar cellular components include packed red blood cells (PRBC), washed PRBC, leukoreduced PRBC and pooled or aphaeresis platelets. Plasma products such as FFP or cryoprecipitate, ant hemophilic factor (CRYO). The transfusion of red blood cells (RBCs), platelets, fresh-frozen plasma (FFP), and cryoprecipitate has the potential of improving clinical outcomes in perioperative and peripartum settings. These benefits include improved tissue oxygenation and decreased bleeding. However, transfusions are not without risks or costs. With the advent of blood component therapy, each unit of whole blood collected serves the specific needs of several, rather than a single patient.Anwer Khan Modern Medical College Journal Vol. 9, No. 2: Jul 2018, P 142-147

Blood Transfusions in Trauma: Six-Year Analysis of the Transfusion Practices at a Level I Trauma Center

2008 ◽  
Vol 74 (10) ◽  
pp. 953-957 ◽  
Author(s):  
Pedro G.R. Teixeira ◽  
Didem Oncel ◽  
Demetrios Demetriades ◽  
Kenji Inaba ◽  
Ira Shulman ◽  
...  
Keyword(s):  
Trauma Center ◽  
Injury Severity ◽  
Negative Impact ◽  
Fresh Frozen Plasma ◽  
Blood Transfusions ◽  
Trauma Patients ◽  
Packed Red Blood Cells ◽  
Fresh Frozen ◽  
Level I ◽  
Injured Patients

The objective of this study was to analyze the transfusion practices in trauma patients in one institution. A retrospective analysis of the Trauma Registry linked with the Blood Bank Database of a Level 1 trauma center was conducted. Over 6 years, 17 per cent of the 25,599 trauma patients received blood transfusions. The overall mortality in transfused patients was 20 per cent and remained the same during the study period. There was no change in the proportion of patients receiving transfusions throughout the years, however there was a significant 23.5 per cent reduction in the mean number of packed red blood cells (PRBC) units transfused (P < 0.001 for trend). This reduction in PRBC used remained true and even more evident in the group of more severely injured patients (Injury Severity Score ≥ 16), with a 27.9 per cent decrease in mean units of PRBC (P < 0.001 for trend). The highest reduction in PRBC transfusion was seen in blunt trauma patients (34.6%, P < 0.001). During the study period there was a concurrent increase in mean units of fresh frozen plasma used (60.7%, P < 0.001) and no change in the use of platelets and cryoprecipitate. In conclusion, transfusions of PRBC were significantly reduced over time in trauma patients without any evident negative impact on mortality.

The Use of Recombinant FVIIa in a Structured Massive Transfusion Protocol: A Novel Approach.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 4142-4142
Author(s):  
Majed A. Refaai ◽  
Kathryn Tchorz ◽  
John Forestner ◽  
Raymond Morris ◽  
Marty Koch ◽  
...  
Keyword(s):  
Massive Transfusion ◽  
Blood Type ◽  
Blood Component ◽  
P Value ◽  
Trauma Patients ◽  
Blood Products ◽  
Packed Red Blood Cells ◽  
Massive Transfusion Protocol ◽  
Novel Approach ◽  
Transfusion Protocol

Abstract Background: Trauma has become the second leading cause of death worldwide, despite advances in modern trauma resuscitation practices. Appropriate and timely blood component therapy in the severely injured trauma patient could prevent adverse outcome due to coagulopathy. Recombinant FVIIa has been used to achieve adequate hemostasis in trauma patients in the field. Materials and Methods: In June 2004, a massive transfusion protocol (MTP) was established in Parkland Memorial Hospital in Dallas, TX for patients presenting with trauma. Major goals of the MTP were 1) to achieve faster turn around times for these products, 2) to provide an appropriate ratio of blood components in order to prevent coagulopathy of massive transfusion and use of rFVIIa to achieve better hemostasis, and 3) to reduce wastage of blood products. At all times, the Blood Bank keeps ready for emergency release 4 units each of type A and O thawed plasma (TP) and 2 units of AB TP (5 days expiration). The MTP consists of three shipments that may be repeated, if necessary. Each shipment consists of 5 packed red blood cells (PRBCs) and 2 TP. One dose of platelets is added to the second shipment, and one dose of cryoprecipitate (10 units) and rFVIIa (4.8 mg) is added to the third shipment. If the MTP goes to the 6th shipment, 2.4 mg rFVIIa is given. Once initiated, the first MTP shipment is ready for pick up in 15 minutes. If blood type can not be determined, type O RBCs with type AB TP are sent in the first shipment (Rh matching depends upon inventory and the patient’s gender). We compared MTP blood component usage in 173 trauma patients during a 24-months period with pre-MTP historical data in 67 trauma patients from the previous 12 months. Results: The average TAT of the first shipment in MTP was 9 ± 0.4 minutes. No TAT assessments of the first shipment were possible in the pre-MTP cases because there was no initiation time available. When comparing the average TATs of second and third shipments of MTP versus pre-MTP cases, however, significant reductions were achieved (18 ± 1.8 vs. 42 ± 30 and 30 ± 2.5 vs. 44 ± 31 minutes, respectively). There was a significant reduction in blood component usage with MTP as compared to pre-MTP (Table) though the mortality had not changed. The blood component wastage (especially cryoprecipitate) had decreased significantly. Conclusions: There was a significant reduction in TAT and blood products used in following establishment of MTP; this was most likely due to prevention and/or early treatment of dilutional coagulopathy and achievement of adequate hemostasis with use of rFVIIa. Table Group PRBCs Thawed Plasma Platelets CRYO rFVIIa TAT (2nd Shipment) TAT (3rd Shipment) *Pre-MTP (n = 20), CRYO = cryoprecipitate, TAT = turn-around time, N/P = not performed Pre-MTP (n = 67) 24.2 ± 16.3 11.2 ± 8.3 3.1 ± 3.5 1.6 ± 1.7 0.2 ± 0.4 42 ± 30* 44 ± 31* MTP (n = 173) 17.5 ± 12.4 6.7 ± 5.6 1.2 ± 1.4 0.7 ± 0.8 0.4 ± 0.6 18 ± 1.8 33 ± 2.5 P value 0.0055 &lt;0.001 &lt;0.001 &lt;0.001 00.0032 N/P N/P

scholarly journals Volume Resuscitation in the Acutely Hemorrhaging Patient: Historic Use to Current Applications

2021 ◽  
Vol 8 ◽  
Author(s):  
Kelly Hall ◽  
Kenneth Drobatz
Keyword(s):  
Blood Pressure ◽  
Blood Loss ◽  
Small Animal ◽  
Blood Component ◽  
Clinical Approach ◽  
Volume Resuscitation ◽  
Acute Hemorrhage ◽  
Blood Component Therapy ◽  
Canine Models ◽  
Crystalloid Administration

Acute hemorrhage in small animals results from traumatic and non-traumatic causes. This review seeks to describe current understanding of the resuscitation of the acutely hemorrhaging small animal (dog and cat) veterinary patient through evaluation of pre-clinical canine models of hemorrhage and resuscitation, clinical research in dogs and cats, and selected extrapolation from human medicine. The physiologic dose and response to whole blood loss in the canine patient is repeatable both in anesthetized and awake animals and is primarily characterized clinically by increased heart rate, decreased systolic blood pressure, and increased shock index and biochemically by increased lactate and lower base excess. Previously, initial resuscitation in these patients included immediate volume support with crystalloid and/or colloid, regardless of total volume, with a target to replace lost vascular volume and bring blood pressure back to normal. Newer research now supports prioritizing hemorrhage control in conjunction with judicious crystalloid administration followed by early consideration for administration of platelets, plasma and red blood during the resuscitation phase. This approach minimizes blood loss, ameliorates coagulopathy, restores oxygen delivery and correct changes in the glycocalyx. There are many hurdles in the application of this approach in clinical veterinary medicine including the speed with which the bleeding source is controlled and the rapid availability of blood component therapy. Recommendations regarding the clinical approach to volume resuscitation in the acutely hemorrhaging veterinary patient are made based on the canine pre-clinical, veterinary clinical and human literature reviewed.

Out and Out It Goes . . . Where It Stops . . . Who Knows

2020 ◽  
pp. 23-32
Author(s):  
Danny Lammers ◽  
Christopher Marenco ◽  
Woo Do ◽  
John Horton
Keyword(s):  
Hemorrhagic Shock ◽  
Blood Cells ◽  
Early Recognition ◽  
Pediatric Trauma ◽  
Standard Of Care ◽  
Fresh Frozen Plasma ◽  
Trauma Patients ◽  
Packed Red Blood Cells ◽  
Fresh Frozen ◽  
Frozen Plasma

Pediatric trauma is the leading cause of death among children and adolescents. Unique variations in pediatric trauma patients require different approaches for pediatric patients than for adult patients. Early recognition of the subtle presentation of hemorrhagic shock is critical to initiate adequate resuscitation. The early use of blood transfusions is indicated for those nonresponsive to crystalloid boluses. Standard of care targets a goal of balanced administration of packed red blood cells (PRBC), fresh frozen plasma (FFP), and platelets (PLT): 1PRBC:1FFP:1PLT. Thromboelastography (TEG) and tranexamic acid (TXA) may have a role in the management of children in hemorrhagic shock.

scholarly journals Platelet consumption during neonatal extracorporeal life support (ECLS)

Perfusion ◽  
1992 ◽  
Vol 7 (1) ◽  
pp. 27-33 ◽  
Author(s):  
Franz B Plötz ◽  
Walter R Wildevuur ◽  
Charles RH Wildevuur ◽  
Ralph E Delius ◽  
Robert H Bartlett
Keyword(s):  
Blood Loss ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Fresh Frozen Plasma ◽  
Entire Period ◽  
Bleeding Complications ◽  
Wound Drainage ◽  
Packed Red Blood Cells ◽  
Neck Wound ◽  
Fresh Frozen

This paper reports the results of a retrospective study of blood use and blood loss in 40 neonates during extracorporeal life support (ECLS). Immediately after onset of bypass 39±2.5ml platelets, 59.4±6.5ml packed red blood cells (PRBC) and 15.0±5.4ml fresh frozen plasma (FFP) per patient were needed. The average daily amount given per patient was 49.0±3.0ml of platelets and 48.0±3.4ml and 9.6±3.9ml of PRBC and FFP respectively. The 10 patients who had bleeding complications received 50.0±6.3ml/day of platelets compared to 49.0±3.4ml in the other patients. The majority of blood loss during the entire period of ECLS was from samples, averaging 43.0 ± 1.5ml/day. Neck wound drainage, 6.7±2.5ml/day per patient, lasted for the entire period.

Adding AB Plasma Units to Emergency Release O Negative Red Blood Cells (RBC) Issued to the Emergency Department (ED)

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 4333-4333
Author(s):  
Jennifer C. Andrews ◽  
Susan Weiss ◽  
Maurene Viele ◽  
Lawrence T Goodnough
Keyword(s):  
Conflicts Of Interest ◽  
Fresh Frozen Plasma ◽  
Blood Component ◽  
Trauma Patients ◽  
Time Period ◽  
Academic Hospitals ◽  
Wastage Rate ◽  
Fresh Frozen ◽  
Level I ◽  
Frozen Plasma

Abstract Abstract 4333 Background: Recent studies have shown improved mortality and decreased early coagulopathy in trauma patients with administration of RBCs, platelets and fresh frozen plasma in a 1:1:1 ratio (Shaz BH et al. Transfusion 2010;50:493–500). As a result, massive transfusion protocols (MTP) have become common at large academic institutions with level I trauma programs. Our institution recently added 2 units of AB plasma to our standard ED trauma cooler which contains 2 units of O negative RBCs and which is ordered by ED staff upon notification of an incoming trauma patient. The treating physicians can escalate blood component support by ordering an MTP if indicated. The purpose of this study was to assess the use and wastage of plasma and RBCs in the ED trauma cooler. Methods: Orders received for the trauma cooler from January 1 2011 to June 30 2011 at a large academic Trauma I center were reviewed retrospectively. Transfusions of RBC and plasma for each order were assessed as well as wastage of plasma or RBCs not transfused. Patients may have used more blood products than initially issued in the ED trauma cooler. Results: Ninety one orders were received for an ED trauma cooler during the 6-month period assessed. Fifteen (16%) of 91 orders resulted in transfusion of RBCs. Nine (10%) of 91 orders resulted in transfusion of plasma. Five of 182 (3%) plasma units issued were wasted because temperature parameters were exceeded before return to the transfusion service (TS). No untransfused RBC units were wasted and all were returned to available inventory. See table. The 15 O negative RBC units transfused from the ED trauma cooler during this time period represent 0.8% (15/1891) of our medical center's transfused O negative RBC units, and the 14 AB plasma units transfused or wasted from the ED trauma cooler represent 2% (14/573) of the AB plasma units transfused by the TS. Conclusion: Of the 48 academic hospitals participating in the 2009 University Health System Consortium (UHC) Efficient Blood Management Benchmarking Project, the published mean wastage of plasma was 3.36% (range 0.36% – 9.44%). Our 3% wastage rate for AB plasma in the ED trauma cooler was within this range. The addition of 2 units of AB plasma to the ED trauma cooler with 2 units of O negative RBCs was feasible at our institution with acceptable wastage of plasma and no undue strain on our supply and inventory of donor O negative RBC and AB plasma. Disclosures: No relevant conflicts of interest to declare.

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