title: How I treat patients with massive hemorrhage.
abstract: Massive hemorrhage is associated with coagulopathy and high mortality. The transfusion guidelines up to 2006 recommended that resuscitation of massive hemorrhage should occur in successive steps using crystalloids, colloids, and red blood cells (RBCs) in the early phase and plasma and platelets in the late phase. With the introduction of the cell-based model of hemostasis in the mid-1990s, our understanding of the hemostatic process and of coagulopathy has improved. This has contributed to a change in resuscitation strategy and transfusion therapy of massive hemorrhage along with an acceptance of the adequacy of whole blood hemostatic tests to monitor these patients. Thus, in 2005, a strategy aiming at avoiding coagulopathy by proactive resuscitation with blood products in a balanced ratio of RBC:plasma:platelets was introduced, and this has been reported to be associated with reduced mortality in observational studies. Concurrently, whole blood viscoelastic hemostatic assays have gained acceptance by allowing a rapid and timely identification of coagulopathy along with enabling an individualized, goal-directed transfusion therapy. These strategies joined together seem beneficial for patient outcome, although final evidence on outcome from randomized controlled trials are lacking. We present how we in Copenhagen and Houston, today, manage patients with massive hemorrhage.
authors.affiliation: Section for Transfusion Medicine, Capital Region Blood Bank, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Surgery, Division of Acute Care Surgery, Centre for Translational Injury Research, University of Texas Health Medical School, Houston, TX; and.
authors.forename: Pär I
authors.initials: PI
authors.lastname: Johansson
authors.affiliation: Section for Transfusion Medicine, Capital Region Blood Bank, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; The Trauma Centre, Department of Anesthesia, Centre of Head and Orthopedics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Jakob
authors.initials: J
authors.lastname: Stensballe
authors.affiliation: Section for Transfusion Medicine, Capital Region Blood Bank, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark;
authors.forename: Roberto
authors.initials: R
authors.lastname: Oliveri
authors.affiliation: Department of Surgery, Division of Acute Care Surgery, Centre for Translational Injury Research, University of Texas Health Medical School, Houston, TX; and.
authors.forename: Charles E
authors.initials: CE
authors.lastname: Wade
authors.affiliation: Section for Transfusion Medicine, Capital Region Blood Bank, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark;
authors.forename: Sisse R
authors.initials: SR
authors.lastname: Ostrowski
authors.affiliation: Department of Surgery, Division of Acute Care Surgery, Centre for Translational Injury Research, University of Texas Health Medical School, Houston, TX; and.
authors.forename: John B
authors.initials: JB
authors.lastname: Holcomb
mesh_terms: D001803:Blood Transfusion / Q000379:methods*; D006470:Hemorrhage / Q000175:diagnosis / Q000628:therapy*; D006487:Hemostasis; D006490:Hemostatics / Q000627:therapeutic use; D006801:Humans; D012151:Resuscitation / Q000379:methods*
chemical_list: D006490:Hemostatics