Transfusion management of trauma patients.

Published

Journal Article (Review)

The management of massively transfused trauma patients has improved with a better understanding of trauma-induced coagulopathy, the limitations of crystalloid infusion, and the implementation of massive transfusion protocols (MTPs), which encompass transfusion management and other patient care needs to mitigate the "lethal triad" of acidosis, hypothermia, and coagulopathy. MTPs are currently changing in the United States and worldwide because of recent data showing that earlier and more aggressive transfusion intervention and resuscitation with blood components that approximate whole blood significantly decrease mortality. In this context, MTPs are a key element of "damage control resuscitation," which is defined as the systematic approach to major trauma that addresses the lethal triad mentioned above. MTPs using adequate volumes of plasma, and thus coagulation factors, improve patient outcome. The ideal amounts of plasma, platelet, cryoprecipitate and other coagulation factors given in MTPs in relationship to the red blood cell transfusion volume are not known precisely, but until prospective, randomized, clinical trials are performed and more clinical data are obtained, current data support a target ratio of plasma:red blood cell:platelet transfusions of 1:1:1. Future prospective clinical trials will allow continued improvement in MTPs and thus in the overall management of patients with trauma.

Full Text

Duke Authors

Cited Authors

  • Shaz, BH; Dente, CJ; Harris, RS; MacLeod, JB; Hillyer, CD

Published Date

  • June 2009

Published In

Volume / Issue

  • 108 / 6

Start / End Page

  • 1760 - 1768

PubMed ID

  • 19448199

Pubmed Central ID

  • 19448199

Electronic International Standard Serial Number (EISSN)

  • 1526-7598

Digital Object Identifier (DOI)

  • 10.1213/ane.0b013e3181a0b6c6

Language

  • eng

Conference Location

  • United States