Massive transfusion
Revision as of 02:37, 6 September 2015 by Ostermayer (talk | contribs) (→Additional Considerations)
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 patients with significant hemorrhageCite error: Closing
</ref>missing for<ref>tag - Thromboelastography (TEG) has been extensively studied in cardiac surgery and quantifies the coagulation cascade
- Factor VII, studied in the CONTROL trial, [5] showed no mortality benefit – in fact, to this effect, the study 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
- ↑ J Trauma. 2010 Sep;69(3):489-500. doi: 10.1097/TA.0b013e3181edf36e.