title: Trauma-associated bleeding: management of massive transfusion.
abstract: OBJECTIVE
  Early treatment goals in the bleeding trauma patient have changed based on recent research findings. Trauma patients requiring a massive transfusion protocol have shown a decreased mortality based on a more aggressive and balanced approach to blood product resuscitation. This chapter will review the recent advances in managing the bleeding trauma patient.
  
  
  RESULTS
  Recent data have suggested a combined approach of early ratio-based blood product use, bedside viscoelastic hemostatic assays, hemostatic resuscitation, and finally goal-directed therapy to complete resuscitation.
  
  
  CONCLUSIONS
  There is now evidence to support the early use of a 1 : 1 : 1 blood product transfusion protocol to restore lost circulating volume, improve oxygen carrying capacity, replace diluted platelets, and replenish clotting factors in massively bleeding trauma patients. Further study is needed to determine whether prehospital initiation of blood products and pharmacological adjuncts will improve outcomes.
authors.affiliation: aDepartment of Anesthesiology, Division of Trauma Anesthesiology bCenter for Translational Injury Research cDepartment of Surgery, Division of Acute Care Surgery, The University of Texas Health Science Center at Houston, Houston, Texas, USA.
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Stephens
authors.forename: Sam
authors.initials: S
authors.lastname: Gumbert
authors.forename: John B
authors.initials: JB
authors.lastname: Holcomb
mesh_terms: D001777:Blood Coagulation; D001779:Blood Coagulation Factors / Q000627:therapeutic use*; D001780:Blood Coagulation Tests; D016913:Blood Component Transfusion / Q000379:methods* / Q000592:standards / Q000639:trends; D002985:Clinical Protocols; D006470:Hemorrhage / Q000209:etiology / Q000628:therapy*; D006487:Hemostasis; D006801:Humans; D015601:Injury Severity Score; D017410:Practice Guidelines as Topic; D014481:United States; D014947:Wounds and Injuries / Q000150:complications / Q000628:therapy*
chemical_list: D001779:Blood Coagulation Factors