Journal article
Massive transfusion: new insights
Chest, Vol.136(6), pp.1654-1667
12/01/2009
DOI: 10.1378/chest.09-0251
PMID: 19995767
Abstract
Massive transfusion (MT) is used for the treatment of uncontrolled hemorrhage. Earlier definitive control of life-threatening hemorrhage has significantly improved patient outcomes, but MT is still required. A number of recent advances in the area of MT have emerged, including the use of "hypotensive" or "delayed" resuscitation for victims of penetrating trauma before hemorrhage is controlled and "hemostatic resuscitation" with increased use of plasma and platelet transfusions in an attempt to maintain coagulation. These advances include the earlier use of hemostatic blood products (plasma, platelets, and cryoprecipitate), recombinant factor VIIa as an adjunct to the treatment of dilutional and consumptive coagulopathy, and a reduction in the use of isotonic crystalloid resuscitation. MT protocols have been developed to simplify and standardize transfusion practices. The authors of recent studies have advocated a 1:1:1 ratio of packed RBCs to fresh frozen plasma to platelet transfusions in patients requiring MT to avoid dilutional and consumptive coagulopathy and thrombocytopenia, and this has been associated with decreased mortality in recent reports from combat and civilian trauma. Earlier assessment of the exact nature of abnormalities in hemostasis has also been advocated to direct specific component and pharmacologic therapy to restore hemostasis, particularly in the determination of ongoing fibrinolysis.
Details
- Title: Subtitle
- Massive transfusion: new insights
- Creators
- Kristen C Sihler - University of Michigan–Ann ArborLena M Napolitano - University of Michigan–Ann Arbor
- Resource Type
- Journal article
- Publication Details
- Chest, Vol.136(6), pp.1654-1667
- DOI
- 10.1378/chest.09-0251
- PMID
- 19995767
- ISSN
- 0012-3692
- eISSN
- 1931-3543
- Language
- English
- Date published
- 12/01/2009
- Academic Unit
- Surgery
- Record Identifier
- 9984746168602771
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