Massive transfusion: Difference between revisions
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==Adjunctive Agents== | ==Adjunctive Agents== | ||
*[[Tranexamic acid|Tranexamic acid (TXA)]] lowers risk of death if administed in less then 3 hours after injury in patients with significant hemorrhage | *[[Tranexamic acid|Tranexamic acid (TXA)]] lowers risk of death if administed in less then 3 hours after injury in trauma patients with significant hemorrhage<ref>Shakur H, et al. "Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage". The Lancet. 2010. 376(9734):23-32.</ref> | ||
*[[Thromboelastography (TEG)]] has been extensively studied in cardiac surgery and quantifies the coagulation cascade | *[[Thromboelastography (TEG)]] has been extensively studied in cardiac surgery and quantifies the coagulation cascade | ||
*Factor VII, studied in the CONTROL trial, <ref>J Trauma. 2010 Sep;69(3):489-500. | *Factor VII, studied in the CONTROL trial, <ref>Hauser CJ. et al. Results of the CONTROL trial: efficacy and safety of recombinant activated Factor VII in the management of refractory traumatic hemorrhage. J Trauma. 2010 Sep;69(3):489-500. d</ref> showed no mortality benefit and was terminated early. | ||
**Other studies of Factor VII have raised concerns for [[MI]] and adverse thrombotic events. | |||
==See Also== | ==See Also== | ||
Revision as of 02:41, 6 September 2015
Background
- Although massive transfusion (MTP) does not have a universal definition, it is generally described as transfusion of >10 units of blood products (specifically Packed red blood cells within a 24-hour period.
- In addition to controlling hemorrhage the greatest concern during MTP is the lethal triad:[1]
- Hypothermia
- Coagulopathy
- Acidosis
- During MTP, focus is on "balanced resuscitation" with clotting factors (FFP) and platelets”[2]
- The goal of MTP is to resuscitate and temporize management until definitive operative repair can be accomplished.
Indications
- Hemorrhagic shock is the only indication for a massive transfusion.
Management
- MTP should follow should follow local institutional protocols[3]
- The PROPPR trial[4] examined a 1:1:1 (FFP:Plt:pRBC) vs 1:1:2 protocol. There was no difference in mortality at 1 or 30 days; however, the 1:1:1 group experienced less death due to exsanguination in the first day.
Adjunctive Agents
- Tranexamic acid (TXA) lowers risk of death if administed in less then 3 hours after injury in trauma patients with significant hemorrhage[5]
- Thromboelastography (TEG) has been extensively studied in cardiac surgery and quantifies the coagulation cascade
- Factor VII, studied in the CONTROL trial, [6] showed no mortality benefit and was terminated early.
- Other studies of Factor VII have raised concerns for MI and adverse thrombotic events.
See Also
References
- ↑ Kashuk JL, et al. Major abdominal vascular trauma — A unified approach. J Trauma. 1982;22(8):672–679.
- ↑ Spinella PC. Resuscitation and transfusion principles for traumatic hemorrhagic shock. Blood Rev. Blood Rev. 2009 Nov;23(6):231-40.
- ↑ ACS TQIP Massive Transfusion in Trauma Guidelines fulltext
- ↑ Holcomb J. et al. Transfusion of Plasma, Platelets, and Red Blood Cells in a 1:1:1 vs a 1:1:2 Ratio and Mortality in Patients With Severe Trauma The PROPPR Randomized Clinical Trial JAMA. 2015
- ↑ Shakur H, et al. "Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage". The Lancet. 2010. 376(9734):23-32.
- ↑ Hauser CJ. et al. Results of the CONTROL trial: efficacy and safety of recombinant activated Factor VII in the management of refractory traumatic hemorrhage. J Trauma. 2010 Sep;69(3):489-500. d