Article

Haemorrhage control in severely injured patients

National Trauma Research Institute, The Alfred Hospital, Monash University, Melbourne, VIC, Australia.
The Lancet (Impact Factor: 39.21). 09/2012; 380(9847):1099–1108. DOI: 10.1016/S0140-6736(12)61224-0

ABSTRACT Most surgeons have adopted damage control surgery for severely injured patients, in which the initial operation is abbreviated after control of bleeding and contamination to allow ongoing resuscitation in the intensive-care unit. Developments in early resuscitation that emphasise rapid control of bleeding, restrictive volume replacement, and prevention or early management of coagulopathy are making definitive surgery during the first operation possible for many patients. Improved topical haemostatic agents and interventional radiology are becoming increasingly useful adjuncts to surgical control of bleeding. Better understanding of trauma-induced coagulopathy is paving the way for the replacement of blind, unguided protocols for blood component therapy with systemic treatments targeting specific deficiencies in coagulation. Similarly, treatments targeting dysregulated inflammatory responses to severe injury are under investigation. As point-of-care diagnostics become more suited to emergency environments, timely targeted intervention for haemorrhage control will result in better patient outcomes and reduced demand for blood products. Our Series paper describes how our understanding of the roles of the microcirculation, inflammation, and coagulation has shaped new and emerging treatment strategies.

0 Bookmarks
 · 
64 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Hemostatic resuscitation might improve the survival of severely injured trauma patients. Our objective was to establish a simplified screening system for determining the necessity of massive transfusions (MT) at an early stage in trauma cases. We retrospectively analyzed the cases of trauma patients who had been transported to our institution between November 2011 and October 2013. Patients who were younger than 18 years of age or who were confirmed to have suffered a cardiac arrest at the scene or on arrival were excluded. MT were defined as transfusions involving the delivery of ≥10 units of red blood cell concentrate within the first 24 h after arrival. A total of 259 trauma patients were included in this study (males: 178, 69%). Their mean age was 49 ± 20, and their median injury severity score was 14.4. Thirty-three (13%) of the patients required MT. The presence of a shock index of ≥1, a base excess of ≤ -3 mmol/L, or a positive focused assessment of sonography for trauma (FAST) result was found to exhibit sensitivity and specificity values of 0.97 and 0.81, respectively, for predicting the necessity of MT. Furthermore, this method displayed an area under the receiver operating characteristic curve of 0.934 (95% confidence interval, 0.891-0.978), which indicated that it was highly accurate. Our screening method based on the shock index, base excess, and FAST result is a simple and useful way of predicting the necessity of MT early after trauma.
    01/2014; 2(1):54. DOI:10.1186/s40560-014-0054-3
  • [Show abstract] [Hide abstract]
    ABSTRACT: Adsorption of plasma proteins to nanomaterial surfaces has a great influence on their bio-functionality. However, there is limited understanding of the relationship between the functional proteins in the protein corona and the biological identity of the materials. Here we show that the in situ generated thrombin in the protein corona of a Ca-zeolite surface displays a calcium-dependent, unusually high (∼3,000 NIH U/mg) procoagulant activity, which is even stable against antithrombin deactivation. Removing the encapsulated Ca2+ in the zeolites leads to deactivation by antithrombin. Our observations suggest that the thrombin activity can be regulated by the inorganic surface and cations. Most importantly, our discovery indicates the link between the biomolecules in the protein corona and the procoagulant activity of the materials, providing a new molecular basis for the procoagulant mechanism for zeolite hemostatics.
    Nano Research 10/2014; 7(10). DOI:10.1007/s12274-014-0505-0 · 6.96 Impact Factor
  • Source
    Scandinavian Journal of Trauma Resuscitation and Emergency Medicine 12/2014; 22(1):763. DOI:10.1186/1757-7241-22-S1-A4 · 1.93 Impact Factor