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Transfusion practice in military trauma
Author(s) -
Hess J. R.,
Holcomb J. B.
Publication year - 2008
Publication title -
transfusion medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.471
H-Index - 59
eISSN - 1365-3148
pISSN - 0958-7578
DOI - 10.1111/j.1365-3148.2008.00855.x
Subject(s) - coagulopathy , medicine , resuscitation , fresh frozen plasma , hemostasis , hemorrhagic shock , shock (circulatory) , transfusion therapy , intensive care medicine , packed red blood cells , disseminated intravascular coagulation , platelet , whole blood , traumatic shock , blood transfusion , blood loss , anesthesia , emergency medicine , surgery
summary Modern warfare causes severe injuries, and despite rapid transportation to theater regional trauma centers, casualties frequently arrive coagulopathic and in shock. Conventional resuscitation beginning with crystalloid fluids to treat shock causes further dilutional coagulopathy and increased hemorrhagic loss of platelets and coagulation factors. Established coagulopathy was difficult to reverse in the face of uncontrolled hemorrhage. Because many of the casualties met conventional plasma and platelet transfusion criteria on admission, thawed AB plasma was prepositioned in the trauma receiving area and used in a 1:1 ratio with red cells for resuscitation and fresh whole blood was used as a source of platelets. Retrospective assessments of this 1:1 therapy strongly suggested that it resulted in improved hemostasis, shorter ventilator times, and improved survival. Component therapy, when available, appears to be as effective as fresh whole blood. In field emergencies, fresh whole blood can be lifesaving.