Anesthetic management of a patient with hollow viscus perforation due to blunt abdominal trauma with grade IV hemorrhagic shock

Hemorrhagic shock is a form of hypovolemic shock in which severe blood loss leads to inadequate oxygen delivery at the cellular level. Death from hemorrhage represents a substantial global problem, with more than 60,000 deaths per year in the United States and an estimated 1.9 million deaths per year worldwide, 1.5 million of which result from physical trauma. This case report aims to stress the need of handling cases of hemorrhagic shock in accordance with damage control protocol. Hemorrhagic shock management using permissive hypotension management, bleeding control, massive transfusion protocol (MTP), minimal crystalloid therapy, and adjuvant therapy is the best approach to get optimal outcome to prevent triad of death. In this case, the application of damage control resuscitation has not been fully implemented because of several constraints. Key words: Hemorrhage; Hemorrhagic shock; Permissive hypotension; Massive Transfusion Protocol; MTP; Resuscitation; Damage control Citation: Pohan DK, Sudjud RW, Kurniawan MB, Ramila HN. Anesthetic management on patient with hollow viscus perforation due to blunt abdominal trauma with grade IV hemorrhagic shock. Anaesth. pain intensive care 2021;25(2):217-221. DOI: 10.35975/apic.v25i2.1474 Received: 11 January 2021, Reviewed: 15 January 2021, Accepted: 16 February 2021

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Fluid Resuscitation and Massive Transfusion Protocol in Pediatric Trauma

Acta Facultatis Medicae Naissensis ◽

10.1515/afmnai-2016-0010 ◽

2016 ◽

Vol 33 (2) ◽

pp. 91-99

Author(s):

Vesna Marjanović ◽

Ivana Budić

Keyword(s):

Hemorrhagic Shock ◽

Fluid Resuscitation ◽

Early Identification ◽

Massive Transfusion ◽

Pediatric Trauma ◽

Current Data ◽

Trauma Patients ◽

Volume Resuscitation ◽

Massive Transfusion Protocol ◽

Transfusion Protocol

Summary Trauma is the leading cause of morbidity and mortality in children due to the occurrence of hemorrhagic shock. Hemorrhagic shock and its consequences, anemia and hypovolemia, decrease oxygen delivery, due to which appropriate transfusion and volume resuscitation are critical. Guidelines for massive transfusion, in the pediatric trauma, have not been defined yet. Current data indicate that early identification of coagulopathy and its treatment with RBSs, plasma and platelets in a 1:1:1 unit ratio, and limited use of crystalloids may improve survival in pediatric trauma patients.

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Futility of Care in Hemorrhagic Shock: When Prolonging the Massive Transfusion Protocol Is of No Benefit

10.1007/978-3-030-81667-4_4 ◽

2021 ◽

pp. 35-44

Author(s):

Rafael Tolentino ◽

Timothy J. Holleran ◽

Laura S. Johnson

Keyword(s):

Hemorrhagic Shock ◽

Massive Transfusion ◽

Massive Transfusion Protocol ◽

Transfusion Protocol

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Initial Resuscitation of Hemorrhagic Shock and Massive Transfusion Protocol

Operative Techniques and Recent Advances in Acute Care and Emergency Surgery ◽

10.1007/978-3-319-95114-0_46 ◽

2019 ◽

pp. 685-694

Author(s):

Lucio Bucci

Keyword(s):

Hemorrhagic Shock ◽

Massive Transfusion ◽

Initial Resuscitation ◽

Massive Transfusion Protocol ◽

Transfusion Protocol

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Faculty Opinions recommendation of Massive transfusion practices around the globe and a suggestion for a common massive transfusion protocol.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1115127.572094 ◽

2008 ◽

Author(s):

Osvaldo Chiara

Keyword(s):

Massive Transfusion ◽

Massive Transfusion Protocol ◽

Transfusion Protocol

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Faculty Opinions recommendation of Improvements in early mortality and coagulopathy are sustained better in patients with blunt trauma after institution of a massive transfusion protocol in a civilian level I trauma center.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1287960.755060 ◽

2009 ◽

Author(s):

Jonathan Waters ◽

Jay S Raval

Keyword(s):

Blunt Trauma ◽

Trauma Center ◽

Massive Transfusion ◽

Early Mortality ◽

Massive Transfusion Protocol ◽

Level I ◽

Transfusion Protocol

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Blood Provision for Cardiac Ablation (CA) Procedures in the Catheterization Laboratory; a Veteran Affairs Medical Center (VAMC) Experience in a Non-Trauma Center Setting

American Journal of Clinical Pathology ◽

10.1093/ajcp/aqaa161.365 ◽

2020 ◽

Vol 154 (Supplement_1) ◽

pp. S167-S168

Author(s):

J M Petersen ◽

V Patel ◽

D Jhala

Keyword(s):

Quality Assurance ◽

Massive Transfusion ◽

Medical Center ◽

Case Series ◽

Blood Bank ◽

Cardiac Ablation ◽

Cardiac Perforation ◽

Catheterization Laboratory ◽

Massive Transfusion Protocol ◽

Transfusion Protocol

Abstract Introduction/Objective Cardiac perforation is a life-threatening complication (~1% risk, with reported rates between 0.2% to 5%) of CA procedures. As cardiac perforation may lead to extensive bleeding, it would be reasonable for a medical center carrying out CA to be capable of arranging for a massive transfusion protocol and for surgical repair as required. However, there is sparse literature to guide a non-trauma medical center implementing a CA program on what the number of red blood cell (RBC) units for crossmatch should be for each case. Methods In interdisciplinary collaborative meetings, the CA program logistics were agreed to between the multiple clinical services. Given the case series on the amount of drained blood in complicated cases, there was agreement that three units of RBCs would be crossmatched for each case. Education was provided on the massive transfusion protocol and on blood bank procedures. As part of quality assurance/quality improvement, records were reviewed from the beginning of the CA program (10/1/2019) to 1/31/2019 to determine number of patient cases, crossmatched units, and transfused units for quality assurance purposes. Results A total of fifteen patients underwent CA procedures, for which three units were crossmatched for each patient. As there were no cardiac perforations with the cardiac ablation procedures so far, no units were transfused. The organized approach for ensuring adequate blood bank support and education led to the reassurance, alleviation of clinical anxiety, and building of a successful CA program. Education sessions completed with thorough understanding of blood bank procedures including the massive transfusion protocol, labeling of blood bank specimens, and on ordering of blood for crossmatch. Conclusion This study provides a reference that may provide helpful guidance to other blood banks on what the number of RBCs to be crossmatched prior to each CA procedure. Multidisciplinary collaborative meetings in advance are an essential component for ensuring adequate support for CA procedures or any new service that requires blood product support. Thorough education of clinical staff on blood bank procedures particularly the massive transfusion protocol is also recommended. This procedure for massive transfusion should be available to be referred to in real time.

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