Massive transfusion and nonsurgical hemostatic agents.
BACKGROUND
Hemorrhage in trauma is a significant challenge, accounting for 30% to 40% of all fatalities, second only to central nervous system injury as a cause of death. However, hemorrhagic death is the leading preventable cause of mortality in combat casualties and typically occurs within 6 to 24 hrs of injury. In cases of severe hemorrhage, massive transfusion may be required to replace more than the entire blood volume. Early prediction of massive transfusion requirements, using clinical and laboratory parameters, combined with aggressive management of hemorrhage by surgical and nonsurgical means, has significant potential to reduce early mortality.


CONCLUSIONS
Although the classification of massive transfusion varies, the most frequently used definition is ten or more units of blood in 24 hrs. Transfusion of red blood cells is intended to restore blood volume, tissue perfusion, and oxygen-carrying capacity; platelets, plasma, and cryoprecipitate are intended to facilitate hemostasis through prevention or treatment of coagulopathy. Massive transfusion is uncommon in civilian trauma, occurring in only 1% to 3% of trauma admissions. As a result of a higher proportion of penetrating injury in combat casualties, it has occurred in approximately 8% of Operation Iraqi Freedom admissions and in as many as 16% during the Vietnam conflict. Despite its potential to reduce early mortality, massive transfusion is not without risk. It requires extensive blood-banking resources and is associated with high mortality.


CONCLUSIONS
This review describes the clinical problems associated with massive transfusion and surveys the nonsurgical management of hemorrhage, including transfusion of blood products, use of hemostatic bandages/agents, and treatment with hemostatic medications.
Perkins
Jeremy G
JG
Hematology/Oncology Service, Walter Reed Army Medical Center, Washington, DC, USA. jeremy.perkins1@us.army.mil
Cap
Andrew P
AP
Weiss
Brendan M
BM
Reid
Thomas J
TJ
Bolan
Charles D
CD
Bolan
Charles E
CE
D000138:Acidosis / Q000209:etiology; D000933:Antifibrinolytic Agents / Q000627:therapeutic use; D001458:Bandages; D001778:Blood Coagulation Disorders / Q000209:etiology; D001803:Blood Transfusion / Q000379:methods*; D002423:Cause of Death; D003422:Critical Care / Q000458:organization & administration*; D003894:Deamino Arginine Vasopressin / Q000627:therapeutic use; D005169:Factor VIII / Q000627:therapeutic use; D015942:Factor VIIa / Q000627:therapeutic use; D005340:Fibrinogen / Q000627:therapeutic use; D006470:Hemorrhage / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D006490:Hemostatics / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D006947:Hyperkalemia / Q000209:etiology; D006996:Hypocalcemia / Q000209:etiology; D007035:Hypothermia / Q000209:etiology; D008887:Military Medicine / Q000458:organization & administration*; D011994:Recombinant Proteins / Q000627:therapeutic use; D012151:Resuscitation / Q000009:adverse effects / Q000379:methods; D012307:Risk Factors; D065227:Transfusion Reaction; D014481:United States / Q000453:epidemiology; D014947:Wounds and Injuries / Q000150:complications*; D017641:Zeolites / Q000627:therapeutic use
D000933:Antifibrinolytic Agents; D006490:Hemostatics; D011994:Recombinant Proteins; C026912:cryoprecipitate coagulum; D017641:Zeolites; D005169:Factor VIII; D005340:Fibrinogen; C103587:recombinant FVIIa; D015942:Factor VIIa; D003894:Deamino Arginine Vasopressin