Massive transfusion: an evidence-based review of recent developments.
The design and implementation of massive transfusion protocols with ratio-based transfusion of blood and blood products are important and active areas of investigation. A significant yet controversial body of literature exists to support the use of hemostatic resuscitation in massive transfusion and new data to support the use of adjuncts, such as recombinant factor VIIa and tranexamic acid. We review the developments in massive transfusion research during the past 5 years, including protocol implementation, hemostatic resuscitation, the use of tranexamic acid, and goal-directed therapy for coagulopathy. Furthermore, we provide a level of evidence analysis of the data surrounding the use of component therapy and recombinant factor VIIa in massive transfusion, summary recommendations for the various agents of resuscitation, and new methods of goal-directed therapy.
Division of General Surgery and Trauma, Department of Surgery, University of Pittsburgh Medical Center, 200 Lothrop St, F675 Watson Surgical Education Center, Presbyterian University Hospital, Pittsburgh, PA 15213, USA. nealm2@upmc.edu
Matthew D
MD
Neal
Alyce
A
Marsh
Ryan
R
Marino
Benjamin
B
Kautza
Jay S
JS
Raval
Raquel M
RM
Forsythe
Gary T
GT
Marshall
Jason L
JL
Sperry
D000933:Antifibrinolytic Agents / Q000627:therapeutic use; D001803:Blood Transfusion / Q000592:standards / Q000639:trends; D002985:Clinical Protocols; D015942:Factor VIIa / Q000627:therapeutic use; D006801:Humans; D010949:Plasma; D017713:Platelet Transfusion / Q000592:standards; D012151:Resuscitation; D014148:Tranexamic Acid / Q000627:therapeutic use
D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid; D015942:Factor VIIa