title: Trends in trauma transfusion.
abstract: Trauma is the leading cause of death in young adults and acute blood loss contributes to a large portion of mortality in the early post-trauma period. The recognition of lethal triad of coagulopathy, hypothermia and acidosis has led to the concepts of damage control surgery and resuscitation. Recent experience with managing polytrauma victims from the Iraq and Afghanistan wars has led to a few significant changes in clinical practice. Simultaneously, transfusion practices in the civilian settings have also been extensively studied retrospectively and prospectively in the last decade. Early treatment of coagulopathy with a high ratio of fresh frozen plasma and platelets to packed red blood cells (FFP:platelet:RBC), prevention and early correction of hypothermia and acidosis, monitoring of hemostasis using point of care tests like thromoboelastometry, use of recombinant activated factor VII, antifibrinolytic drugs like tranexamic acid are just some of the emerging trends. Further studies, especially in the civilian trauma centers, are needed to confirm the lessons learned in the military environment. Identification of patients likely to need massive transfusion followed by immediate preventive and therapeutic interventions to prevent the development of coagulopathy could help in reducing the morbidity and mortality associated with uncontrolled hemorrhage in trauma patients.
authors.affiliation: Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA, USA.
authors.forename: Sanjay M
authors.initials: SM
authors.lastname: Bhananker
authors.forename: Ramesh
authors.initials: R
authors.lastname: Ramaiah
references.citation: J Trauma. 2010 Oct;69(4):976-90
references.pmid: 20938283
references.citation: Arch Surg. 2010 Sep;145(9):899-906
references.pmid: 20855762
references.citation: Anesth Analg. 2010 Nov;111(5):1204-6
references.pmid: 20581160
references.citation: Crit Care. 2007;11(1):R17
references.pmid: 17298665
references.citation: J Trauma. 2005 Jul;59(1):8-15; discussion 15-8
references.pmid: 16096533
references.citation: Transfusion. 2011 Feb;51(2):242-52
references.pmid: 20796254
references.citation: Anesth Analg. 2009 Mar;108(3):770-6
references.pmid: 19224781
references.citation: J Trauma. 2009 Aug;67(2):221-7; discussion 228-30
references.pmid: 19667872
references.citation: Br J Anaesth. 2010 Mar;104(3):318-25
references.pmid: 20133450
references.citation: J Trauma. 2008 Aug;65(2):261-70; discussion 270-1
references.pmid: 18695460
references.citation: J Am Coll Surg. 2010 Nov;211(5):573-9
references.pmid: 20846882
references.citation: Arch Surg. 2010 Jul;145(7):690-4
references.pmid: 20644133
references.citation: J Trauma. 2007 Feb;62(2):307-10
references.pmid: 17297317
references.citation: Transfusion. 2010 Jun;50(6):1370-83
references.pmid: 20345563
references.citation: Anaesthesia. 2010 Nov;65(11):1153-61
references.pmid: 20963925
references.citation: Pediatr Crit Care Med. 2010 May;11(3):420-1
references.pmid: 20453612
references.citation: Anesthesiology. 2010 Nov;113(5):1205-19
references.pmid: 20881594
references.citation: Ann Surg. 2010 Apr;251(4):604-14
references.pmid: 20224372
references.citation: Transfusion. 2001 May;41(5):591-5
references.pmid: 11346691
references.citation: Anesth Analg. 2009 Jun;108(6):1760-8
references.pmid: 19448199
references.citation: Acta Anaesthesiol Scand. 2010 Jan;54(1):111-7
references.pmid: 19860752
references.citation: Lancet. 2010 Jul 3;376(9734):23-32
references.pmid: 20554319
references.citation: Chest. 2009 Dec;136(6):1654-1667
references.pmid: 19995767
references.citation: Curr Opin Crit Care. 2007 Dec;13(6):680-5
references.pmid: 17975390
references.citation: Chest. 2010 Jan;137(1):209-20
references.pmid: 20051407
references.citation: Am Surg. 2006 Jul;72(7):619-25; discussion 625-6
references.pmid: 16875084
references.citation: J Trauma. 2006 Dec;61(6):1419-25
references.pmid: 17159685
references.citation: J Thromb Haemost. 2007 Feb;5(2):289-95
references.pmid: 17109736
references.citation: Anesthesiology. 2006 Jul;105(1):198-208
references.pmid: 16810012
references.citation: J Trauma. 2007 Oct;63(4):805-13
references.pmid: 18090009
references.citation: Ann Surg. 2008 Sep;248(3):447-58
references.pmid: 18791365
references.citation: Vox Sang. 2010 Apr;98(3 Pt 2):395-402
references.pmid: 20432517
references.citation: Arch Surg. 2010 Oct;145(10):973-7
references.pmid: 20956766
references.citation: J Trauma. 2010 Jul;69(1):46-52
references.pmid: 20622577
references.citation: Injury. 2005 Jun;36(6):691-709
references.pmid: 15910820
references.citation: Transfusion. 2010 Jul;50(7):1545-51
references.pmid: 20158684
references.citation: Crit Care. 2010;14(2):R52
references.pmid: 20370902
references.citation: Thromb Res. 2007;120(1):29-37
references.pmid: 16887171
references.citation: Crit Care. 2010;14(2):R55
references.pmid: 20374650
references.citation: J Trauma. 2010 Jul;69 Suppl 1:S33-9
references.pmid: 20622617
references.citation: J Trauma. 2008 Feb;64(2):286-93; discussion 293-4
references.pmid: 18301188
references.citation: J Trauma. 2008 Nov;65(5):986-93
references.pmid: 19001962