Download full-text


Available from: Bryan A Cotton
  • Source
    • "DCR, now listed in surgery textbooks (9) as a method that involves permissive hypotension, limited use of crystalloid fluids, and early use of blood products, is now an essential concept that surgeons have to learn to be able to deal with patients in hypovolemic shock due to hemorrhage, even if they are not patients with trauma (10). However, there are various views on the validity of such a management technique. "
    [Show abstract] [Hide abstract]
    ABSTRACT: When treating trauma patients with severe hemorrhage, massive transfusions are often needed. Damage control resuscitation strategies can be used for such patients, but an adequate fresh frozen plasma: packed red blood cell (FFP:PRBC) administration ratio must be established. We retrospectively reviewed the medical records of 100 trauma patients treated with massive transfusions from March 2010 to October 2012. We divided the patients into 2 groups according to the FFP:PRBC ratio: a high-ratio (≥0.5) and a low-ratio group (<0.5). The patient demographics, fluid and transfusion quantities, laboratory values, complications, and outcomes were analyzed and compared. There were 68 patients in the high-ratio and 32 in the low-ratio group. There were statistically significant differences between groups in the quantities of FFP, FFP:PRBC, platelets, and crystalloids administered, as well as the initial diastolic blood pressure. Bloodstream infections were noted only in the high-ratio group, and the difference was statistically significant (P=0.028). Kaplan-Meier plots revealed that the 24-hr survival rate was significantly higher in the high-ratio group (71.9% vs. 97.1%, P<0.001). In severe hemorrhagic trauma, raising the FFP:PRBC ratio to 0.5 or higher may increase the chances of survival. Efforts to minimize bloodstream infections during the resuscitation must be increased. Graphical Abstract
    Full-text · Article · Jul 2014 · Journal of Korean Medical Science
  • Source
    • "This entails the early and aggressive use of hemostatic products combined with red blood cells as the primary resuscitation fluids in order to avoid rapid deterioration into the “bloody vicious cycle” and the classic “lethal triad” of hypothermia, acidosis and coagulopathy [42]. Two very distinct paradigms of hemostatic resuscitation have currently emerged: the damage control resuscitation (DCR) model, which uses pre-emptive administration of empiric ratios of blood and hemostatic products to approximate whole blood, often according to an established institutional “massive transfusion protocol” [43-47]; and goal-directed hemostatic resuscitation approaches (also often protocol-based), which generally use point-of-care viscoelastic monitoring (Figure 3) combined with the prompt administration of hemostatic concentrates [24,26,27,34]. Regardless, it is highly likely that the patient with massive hemorrhage who arrives to the ICU under-resuscitated with a coagulopathy has been managed according to some sort of hemostatic resuscitation approach which should be continued in the ICU until it is clear that hemostasis has been achieved. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background Care of the polytrauma patient does not end in the operating room or resuscitation bay. The patient presenting to the intensive care unit following initial resuscitation and damage control surgery may be far from stable with ongoing hemorrhage, resuscitation needs, and injuries still requiring definitive repair. The intensive care physician must understand the respiratory, cardiovascular, metabolic, and immunologic consequences of trauma resuscitation and massive transfusion in order to evaluate and adjust the ongoing resuscitative needs of the patient and address potential complications. In this review, we address ongoing resuscitation in the intensive care unit along with potential complications in the trauma patient after initial resuscitation. Complications such as abdominal compartment syndrome, transfusion related patterns of acute lung injury and metabolic consequences subsequent to post-trauma resuscitation are presented. Methods A non-systematic literature search was conducted using PubMed and the Cochrane Database of Systematic Reviews up to May 2012. Results and conclusion Polytrauma patients with severe shock from hemorrhage and massive tissue injury present major challenges for management and resuscitation in the intensive care setting. Many of the current recommendations for “damage control resuscitation” including the use of fixed ratios in the treatment of trauma induced coagulopathy remain controversial. A lack of large, randomized, controlled trials leaves most recommendations at the level of consensus, expert opinion. Ongoing trials and improvements in monitoring and resuscitation technologies will further influence how we manage these complex and challenging patients.
    Full-text · Article · Sep 2012 · Scandinavian Journal of Trauma Resuscitation and Emergency Medicine
  • [Show abstract] [Hide abstract]
    ABSTRACT: Trauma is the leading cause of death in young adults and acute blood loss contributes to a large portion of mortality in the early post-trauma period. The recognition of lethal triad of coagulopathy, hypothermia and acidosis has led to the concepts of damage control surgery and resuscitation. Recent experience with managing polytrauma victims from the Iraq and Afghanistan wars has led to a few significant changes in clinical practice. Simultaneously, transfusion practices in the civilian settings have also been extensively studied retrospectively and prospectively in the last decade. Early treatment of coagulopathy with a high ratio of fresh frozen plasma and platelets to packed red blood cells (FFP:platelet:RBC), prevention and early correction of hypothermia and acidosis, monitoring of hemostasis using point of care tests like thromoboelastometry, use of recombinant activated factor VII, antifibrinolytic drugs like tranexamic acid are just some of the emerging trends. Further studies, especially in the civilian trauma centers, are needed to confirm the lessons learned in the military environment. Identification of patients likely to need massive transfusion followed by immediate preventive and therapeutic interventions to prevent the development of coagulopathy could help in reducing the morbidity and mortality associated with uncontrolled hemorrhage in trauma patients.
    No preview · Article · Jan 2011
Show more