How do we provide blood products to trauma patients?

Division of Transfusion Medicine, Department of Pathology & Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA.
Transfusion (Impact Factor: 3.23). 04/2009; 49(6):1045-9. DOI: 10.1111/j.1537-2995.2009.02150.x
Source: PubMed
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Available from: Alyssa Ziman, Oct 09, 2014
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    ABSTRACT: Unfortunately, we are likely years away from having the answer to settle this debate. The necessary RCTs will be difficult to complete. We would be smart to perform some small pilot studies to identify all of the challenges to a multicenter trial in this difficult patient population. The trials will not be able to be performed without a "waived" consent because of the inclusion of only massively injured patients. The patients will have to be randomized almost immediately upon arrival to the trauma room because of the need to commence formula-driven care along with the first RBC. The blood banks will have to be actively involved to ensure rapid preparation of blood components. In addition, we also have to ensure that the "standard" arm is given appropriate laboratory-driven component support, with prompt turnaround times for coagulation testing. The studies on formula-driven care do not show unequivocal benefit or unequivocal harm. We should not jump toward adopting formula-driven care without considering the potential risks and benefits for trauma patients, and our other patients who require FFP. We thus will need to keep the doors open for such a much needed clinical trial. If formula-driven care is adopted and accepted as standard of care in most trauma hospitals, where will such a trial be done?
    No preview · Article · Oct 2009 · Transfusion medicine reviews
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    ABSTRACT: Care of the patient with massive bleeding involves more than aggressive surgery and infusion of large amounts of blood products. The proper management of massive transfusions-whether they are in trauma patients or other bleeding patients-requires coordination of the personnel in the surgical suite or the emergency department, the blood bank, and laboratory.
    Preview · Article · Dec 2010 · Hematology
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    ABSTRACT: An effective hospital transfusion culture should encourage clinicians to consider the possibility of transfusion in their patients well before the need actually arises, and to plan ahead in an attempt to use blood products most efficiently. Strategies for improved blood utilization include timely and adequate preoperative assessment of risk, optimization of baseline hemoglobin, anticipation of potential transfusion problems, intraoperative techniques to minimize blood loss, blood conservation technologies, transfusion guidelines and targeted therapy, point of care testing, and massive transfusion protocols. Attention to these elements promotes a safe and cost-effective transfusion culture.
    No preview · Article · Mar 2012 · Journal of clinical anesthesia
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