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REVIEW
Angela Saviano, Cesare Perotti, Christian Zanza, Yaroslava Longhitano, Veronica Ojetti, Francesco Franceschi, Abdelouahab Bellou, Andrea Piccioni, Eugenio Jannelli, Iride Francesca Ceresa, Gabriele Savioli
Severe bleeding is the leading cause of death in patients with major trauma admitted to the emergency department. It is estimated that about 50% of deaths happen within a few minutes of the traumatic event due to massive hemorrhage; 30% of deaths are related to neurological dysfunction and typically happen within two days of trauma; and approximately 20% of patients died of multiorgan failure and sepsis within days to weeks of the traumatic event. Over the past ten years, there has been an increased understanding of the underlying mechanisms and pathophysiology associated with traumatic bleeding leading to improved management measures...
March 27, 2024: Diagnostics
#2
JOURNAL ARTICLE
David T Lubkin, Krislynn M Mueck, Gabrielle E Hatton, Jason B Brill, Mariela Sandoval, Jessica C Cardenas, Charles E Wade, Bryan A Cotton
OBJECTIVES: Some centers have recommended including concentrated fibrinogen replacement in massive transfusion protocols (MTPs). Given our center's policy of aggressive early balanced resuscitation (1:1:1), beginning prehospital, we hypothesized that our rates of hypofibrinogenemia may be lower than those previously reported. METHODS: In this retrospective cohort study, patients presenting to our trauma center November 2017 to April 2021 were reviewed. Patients were defined as hypofibrinogenemic (HYPOFIB) if admission fibrinogen <150 or rapid thrombelastography angle <60...
2024: Trauma Surgery & Acute Care Open
#3
JOURNAL ARTICLE
Rachel C Murphy, Tyler W Johnson, Thomas J Mack, Rachel E Burke, Nicholas P Damiano, Laura Heger, Nicholas Minner, Emily German, Angela Wilson, Michael G Mount, Brian C Thurston, Caleb J Mentzer
BACKGROUND: Blood product component-only resuscitation (CORe) has been the standard of practice in both military and civilian trauma care with a 1:1:1 ratio used in attempt to recreate whole blood (WB) until recent data demonstrated WB to confer a survival advantage, leading to the emergence of WB as the contemporary resuscitation strategy of choice. Little is known about the cost and waste reduction associated with WB vs CORe. METHODS: This study is a retrospective single-center review of adult trauma patients admitted to a community trauma center who received WB or CORe as part of their massive transfusion protocol (MTP) resuscitation from 2017 to 2021...
April 9, 2024: American Surgeon
#4
JOURNAL ARTICLE
Yana Shandaliy, Kirsten Busey, Nicholas Scaturo
DISCLAIMER: In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE: Hypocalcemia is associated with increased mortality in trauma patients with hemorrhagic shock who require massive transfusion protocols (MTPs)...
April 5, 2024: American Journal of Health-system Pharmacy: AJHP
#5
JOURNAL ARTICLE
Luciana Correa Oliveira, Juan Carlos Montano-Pedroso, Fernanda Vieira Perini, Roseny Dos Reis Rodrigues, Enis Donizetti, Silvia Renata Cornélio Parolin Rizzo, Guilherme Rabello, Dante Mario Langhi Junior
The management of major bleeding is a critical aspect of modern healthcare and it is imperative to emphasize the importance of applying Patient Blood Management (PBM) principles. Although transfusion support remains a vital component of bleeding control, treating severe bleeding goes beyond simply replacing lost blood. A more comprehensive, multidisciplinary approach is essential to optimize patient outcomes and minimize the risks associated with excessive transfusions.
March 13, 2024: Hematology, Transfusion and Cell Therapy
#6
JOURNAL ARTICLE
Jonathan P Meizoso, Bryan A Cotton, Ryan A Lawless, Lisa M Kodadek, Jennifer M Lynde, Nicole Russell, John Gaspich, Adrian Maung, Christofer Anderson, John M Reynolds, Krista L Haines, George Kasotakis, Jennifer J Freeman
INTRODUCTION: Whole blood resuscitation has reemerged as a resuscitation strategy for injured patients. However, the effect of whole blood-based resuscitation on outcomes has not been established. The primary objective of this guideline was to develop evidence-based recommendations on whether whole blood should be considered in civilian trauma patients receiving blood transfusions. METHODS: An EAST working group performed a systematic review and meta-analysis utilizing the GRADE methodology...
March 27, 2024: Journal of Trauma and Acute Care Surgery
#7
JOURNAL ARTICLE
Steven C Mehl, Adam M Vogel, Amy E Glasgow, Suzanne Moody, Meera Kotagal, Regan F Williams, Mark L Kayton, Emily C Alberto, Randall S Burd, Thomas J Schroeppel, Joanne E Baerg, Amanda Munoz, William B Rothstein, Laura A Boomer, Eric M Campion, Caitlin Robinson, Rachel M Nygaard, Chad J Richardson, Denise I Garcia, Christian J Streck, Michaela Gaffley, John K Petty, Cynthia Greenwell, Samir Pandya, Alicia M Waters, Robert T Russell, Brian K Yorkgitis, Jennifer Mull, Jeffrey Pence, Matthew T Santore, Taleen A MacArthur, Denise B Klinkner, Shawn D Safford, Tanya Trevilian, Megan Cunningham, Christa Black, Jessica Rea, Ryan G Spurrier, Aaron R Jensen, Bethany J Farr, David P Mooney, Bavana Ketha, Melvin S Dassinger, Anna Goldenberg-Sandau, Janika San Roman, Todd M Jenkins, Richard A Falcone, Stephanie F Polites
BACKGROUND: The benefit of targeting high ratio fresh frozen plasma (FFP):red blood cell (RBC) transfusion in pediatric trauma resuscitation is unclear as existing studies are limited to patients who retrospectively met criteria for massive transfusion. The purpose of this study is to evaluate the use of high ratio FFP:RBC transfusion and the association with outcomes in children presenting in shock. METHODS: A post-hoc analysis of a 24-institution prospective observational study (4/2018-9/2019) of injured children <18 years with elevated age-adjusted shock index was performed...
March 18, 2024: Journal of Trauma and Acute Care Surgery
#8
JOURNAL ARTICLE
Praneetha Mude, Monalisa Pradhan, Anuj Tiwari, Tapas Kanti Parida, Manoj Kumar Nayak, Arun Kumar Sekar, Suvendu Purkait, Usha Devi
A term neonate with history of ventriculomegaly in the fetal period was diagnosed with a central nervous system tumour after radiological investigations. It was confirmed as an immature teratoma after histopathological examination. He underwent left frontal craniotomy with tumour excision. Intraoperatively, massive haemorrhage (venous bleed) occurred due to the high vascularity of the tumour and led to haemodynamic instability. A massive transfusion protocol was initiated. Despite multiple transfusions and shock management, he succumbed at 2 weeks of life...
March 15, 2024: BMJ Case Reports
#9
REVIEW
Jan-Michael Van Gent, Thomas W Clements, Bryan A Cotton
Start balanced resuscitation early (pre-hospital if possible), either in the form of whole blood or 1:1:1 ratio. Minimize resuscitation with crystalloid to minimize patient morbidity and mortality. Trauma-induced coagulopathy can be largely avoided with the use of balanced resuscitation, permissive hypotension, and minimized time to hemostasis. Using protocolized "triggers" for massive and ultramassive transfusion will assist in minimizing delays in transfusion of products, achieving balanced ratios, and avoiding trauma induced coagulopathy...
April 2024: Surgical Clinics of North America
#10
JOURNAL ARTICLE
John C Alverdy, Ann Polcari, Andrew Benjamin
Post-injury infection continues to plague trauma and emergency surgery patients fortunate enough to survive the initial injury. Rapid response systems, massive transfusion protocols, the development of level 1 trauma centers, etc., have improved the outcome for millions of patients worldwide. Yet despite this excellent initial care, patients still remain vulnerable to post-injury infections that can result in organ failure, prolonged critical illness and even death. While risk factors have been identified (degree of injury, blood loss, time to definitive care, immunocompromise, etc...
March 4, 2024: Journal of Trauma and Acute Care Surgery
#11
JOURNAL ARTICLE
Yosuke Namba, Tsuyoshi Kobayashi, Shintaro Kuroda, Masakazu Hashimoto, Daisuke Takei, Sotaro Fukuhara, Ko Oshita, Keiso Matsubara, Naruhiko Honmyo, Ryosuke Nakano, Hiroshi Sakai, Hiroyuki Tahara, Masahiro Ohira, Kentaro Ide, Hideki Ohdan
BACKGROUND: In patients with chronic liver diseases such as cirrhosis, massive ascites after hepatic resection is the cause of prolonged hospitalization and worsening prognosis. Recently, the efficacy of tolvaptan in refractory ascites has been reported; however, there are no reports on the efficacy or safety of tolvaptan for refractory ascites after hepatic resection. This study aims to evaluate the efficacy of early administration of tolvaptan in patients with refractory ascites after hepatic resection...
March 2024: International journal of surgery protocols
#12
JOURNAL ARTICLE
Nadia M Keltner, Melissa M Cushing, Thorsten Haas, Philip C Spinella
BACKGROUND: Hemorrhage is a leading cause of preventable death in trauma, cardiac surgery, liver transplant, and childbirth. While emphasis on protocolization and ratio of blood product transfusion improves ability to treat hemorrhage rapidly, tools to facilitate understanding of the overall content of a specific transfusion strategy are lacking. Medical modeling can provide insights into where deficits in treatment could arise and key areas for clinical study. By using a transfusion model to gain insight into the aggregate content of massive transfusion protocols (MTPs), clinicians can optimize protocols and create opportunities for future studies of precision transfusion medicine in hemorrhage treatment...
March 3, 2024: Transfusion
#13
Kella L Vangsness, Janelle Lopez, Lauren Van Sant, Thomas Duncan, Graal Diaz
INTRODUCTION AND IMPORTANCE: Lung herniation following trauma is a rare occurrence, and consensus on optimal surgical repair techniques remains limited. While small herniations may resolve without surgery, intervention becomes necessary in cases of unsuccessful non-operative management or concurrent rib fracture stabilization. Mesh application in repair poses a dilemma, often providing physical support but raising infection concerns, particularly in trauma scenarios with delayed closure...
February 27, 2024: International Journal of Surgery Case Reports
#14
JOURNAL ARTICLE
Heiko Lier, Björn Hossfeld
PURPOSE OF REVIEW: The purpose of this review is to provide an overview of currently recommended treatment approaches for traumatic hemorrhage shock, with a special focus on massive transfusion. RECENT FINDINGS: Severe trauma patients require massive transfusion, but consensual international definitions for traumatic hemorrhage shock and massive transfusion are missing. Current literature defines a massive transfusion as transfusion of a minimum of 3-4 packed red blood cells within 1 h...
January 22, 2024: Current Opinion in Anaesthesiology
#15
REVIEW
Mohamed Abuelazm, Hazem Rezq, Abdelrahman Mahmoud, Mohammad Tanashat, Abdelrahman Salah, Othman Saleh, Samah Morsi, Basel Abdelazeem
BACKGROUND AND OBJECTIVE: Plasma is a critical element in hemostatic resuscitation post-injury, and its prompt administration within the prehospital setting may reduce the complications resulting from hemorrhage and shock. Our objective is to assess the efficacy and safety of prehospital plasma infusion in patients susceptible to hemorrhagic shock. METHODS: We conducted our study by aggregating randomized controlled trials (RCTs) sourced from PubMed, EMBASE, Scopus, Web of Science, and Cochrane CENTRAL up to January 29, 2023...
February 17, 2024: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
#16
REVIEW
Michael A Benson, Deborah Tolich, Jeannie L Callum, Moises Auron
Plasma is overused as a blood product worldwide; however, data supporting appropriate use of plasma is scant. Its most common utilization is for treatment of coagulopathy in actively bleeding patients; it is also used for coagulation optimization prior to procedures with specific coagulation profile targets. A baseline literature review in PUBMED and Google Scholar was done (1 January 2000 to 1 June 2023), utilizing the following search terms: plasma, fresh frozen plasma, lyophilized plasma, indications, massive transfusion protocol, liver disease, warfarin reversal, cardiothoracic surgery, INR < 2...
February 16, 2024: Postgraduate Medicine
#17
JOURNAL ARTICLE
Luca Carenzo, Cesare Mercalli, Elisa Reitano, Marco Tartaglione, Martina Ceolin, Stefania Cimbanassi, Daniele Del Fabbro, Fabrizio Sammartano, Maurizio Cecconi, Carlo Coniglio, Osvaldo Chiara, Lorenzo Gamberini
Trauma teams play a vital role in providing prompt and specialized care to trauma patients. This study aims to provide a comprehensive description of the presence and organization of trauma teams in Italy. A nationwide cross-sectional epidemiological study was conducted between July and October 2022, involving interviews with 137 designated trauma centers. Centers were stratified based on level: higher specialized trauma centers (CTS), intermediate level trauma centers (CTZ + N) and district general hospital with trauma capacity (CTZ)...
January 27, 2024: Injury
#18
JOURNAL ARTICLE
Yujung Jung, Oscar Luo, Nina Sen, Flora M Li, Rida A Hasan, Aaron S Hess, John R Hess, Daniel E Sabath, Hamilton C Tsang, Monica B Pagano
BACKGROUND: Administering platelets through a rapid infuser is proven to be safe. However, the clinical significance of infusing ABO-incompatible platelets with red blood cells (RBCs) in a rapid infuser remains unclear. There is a theoretical risk that isoagglutinin in the plasma of a platelet unit can interact with RBCs and induce hemolysis. MATERIALS AND METHODS: Seven in vitro studies were performed including five cases (type A RBCs and type O platelets) and two controls (type A RBCs and platelets)...
February 1, 2024: Transfusion
#19
JOURNAL ARTICLE
Kyle J Kalkwarf, Bryan A Cotton
No abstract text is available yet for this article.
February 1, 2024: American Surgeon
#20
JOURNAL ARTICLE
Thomas Easterday, Saskya Byerly, Louis Magnotti, Peter Fischer, Kinjal Shah, Martin Croce, Andrew Kerwin, Isaac Howley
BACKGROUND: Given the acuity of patients who receive MTPs and the resources they require, MTPs are a compelling target for performance improvement. This study evaluated adherence with our MTP's plasma:red blood cell ratio (FFPR) of 1:2 and platelet:red blood cell ratio (PLTR) of 1:12, to test the hypothesis that ratio adherence is associated with lower inpatient mortality. MATERIALS AND METHODS: The registry of an urban level I trauma center was queried for adult patients who received at least 6 units of packed red blood cells within 4 hours of presentation...
January 31, 2024: American Surgeon
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