title: Intra-operative correction of acidosis, coagulopathy and hypothermia in combat casualties with severe haemorrhagic shock.
abstract: We assessed acidosis, coagulopathy and hypothermia, before and after surgery in 51 combat troops operated on for severe blast injury. Patients were transfused a median (IQR [range]) of 27 (17-38 [5-84]) units of red cell concentrate, 27 (16-38 [4-83]) units of plasma, 2.0 (0.5-3.5 [0-13.0]) units of cryoprecipitate and 4 (2-6 [0-17]) pools of platelets. The pH, base excess, prothrombin time and temperature increased: from 7.19 (7.10-7.29 [6.50-7.49]) to 7.45 (7.40-7.51 [7.15-7.62]); from -9.0 (-13.5 to -4.5 [-28 to -2]) mmol.l⁻¹ to 4.5 (1.0-8.0 [-7 to +11]) mmol.l⁻¹; from 18 (15-21 [9-24]) s to 14 (11-18 [9-21]) s; and from 36.1 (35.1-37.1 [33.0-38.1]) °C to 37.4 (37.0-37.9 [36.0-38.0]) °C, respectively. Contemporary intra-operative resuscitation strategies can normalise the physiological derangements caused by haemorrhagic shock.
authors.affiliation: Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK; US Army Institute of Surgical Research, Fort Sam Houston, San Antonio, Texas, USA.
authors.forename: J J
authors.initials: JJ
authors.lastname: Morrison
authors.forename: J D
authors.initials: JD
authors.lastname: Ross
authors.forename: H
authors.initials: H
authors.lastname: Poon
authors.forename: M J
authors.initials: MJ
authors.lastname: Midwinter
authors.forename: J O
authors.initials: JO
authors.lastname: Jansen
mesh_terms: D000138:Acidosis / Q000209:etiology / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D055826:Afghan Campaign 2001-; D017732:Air Ambulances; D000671:Amputation, Surgical; D001753:Blast Injuries / Q000150:complications / Q000628:therapy*; D001778:Blood Coagulation Disorders / Q000209:etiology / Q000628:therapy*; D001831:Body Temperature; D017707:Erythrocyte Transfusion; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007035:Hypothermia / Q000209:etiology / Q000628:therapy*; D007432:Intraoperative Period; D007869:Leg Injuries / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010949:Plasma; D017713:Platelet Transfusion; D011517:Prothrombin Time; D012151:Resuscitation; D012189:Retrospective Studies; D012771:Shock, Hemorrhagic / Q000150:complications / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult