New developments in massive transfusion in trauma.
OBJECTIVE
Trauma patients requiring massive transfusion represent a population at high risk for potentially preventable death. This review describes recent advances in the early recognition and treatment of the coagulopathy of trauma, as well as ongoing work to define optimal resuscitation strategies.


RESULTS
Damage control resuscitation involves the rapid correction of hypothermia and acidosis, direct treatment of coagulopathy, and early transfusion in trauma patients. Recent evidence demonstrates improved mortality and lower overall blood product usage with higher ratios of plasma and platelets to red blood cells transfused. Adjuncts to damage control resuscitation such as factor VIIa may also be beneficial. Thrombelastography and advances in point-of-care testing may provide timely measurements to help guide massive transfusion in patients based on their individual needs.


CONCLUSIONS
As optimal resuscitation strategies continue to evolve, recent efforts have focused on early and aggressive treatment of coagulopathy, with higher ratios of plasma and platelets to red blood cells transfused. Early evidence suggests that such strategies have a beneficial outcome in regards to trauma-related mortality.
Greer
Sarah E
SE
Dartmouth Hitchcock Medical Center, Departments of Surgery, USA.
Rhynhart
Kurt K
KK
Gupta
Rajan
R
Corwin
Howard L
HL
D001778:Blood Coagulation Disorders / Q000150:complications; D001803:Blood Transfusion / Q000379:methods*; D015942:Factor VIIa / Q000627:therapeutic use; D006801:Humans; D011994:Recombinant Proteins / Q000627:therapeutic use; D012151:Resuscitation; D013916:Thrombelastography; D014947:Wounds and Injuries / Q000097:blood / Q000628:therapy*
D011994:Recombinant Proteins; D015942:Factor VIIa