Impact of Policy Change on US Army Combat Transfusion Practices
United States Army Institute of Surgical Research, Fort Sam Houston, Texas 78234, USA. The Journal of trauma
(Impact Factor: 2.96).
07/2010; 69 Suppl 1(Supplement):S75-80. DOI: 10.1097/TA.0b013e3181e44952
BACKGROUND: Clinical practice guidelines (CPGs) are used to keep providers up-to-date with the most recent literature and to guide in decision making. Adherence is typically improved although many have a muted impact. In March 2006, the US Army issued a damage control resuscitation CPG, encouraging 1:1 plasma:red blood cell (RBC) transfusions and limiting crystalloid use. The objective of this study was to determine whether the CPG was associated with a change in the transfusion practices in combat-wounded patients.
Available from: Sylvain Ausset
Available from: Klaus Görlinger
- "The MTP published by Dirks et al. resulted in a significant increase in PC transfusion without any improvement in the survival rate . Similar results were reported by Simmons et al., who observed that the introduction of new clinical practice guidelines forcing early platelet transfusion resulted in no survival benefit . Thus, platelet transfusion in a fixed predefined ratio carries the potential for wasting valuable resources and the risk of complications (e.g. "
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ABSTRACT: Severe trauma-related bleeding is associated with high mortality. Standard coagulation tests provide limited information on the underlying coagulation disorder. Whole-blood viscoelastic tests such as rotational thromboelastometry or thrombelastography offer a more comprehensive insight into the coagulation process in trauma. The results are available within minutes and they provide information about the initiation of coagulation, the speed of clot formation, and the quality and stability of the clot. Viscoelastic tests have the potential to guide coagulation therapy according to the actual needs of each patient, reducing the risks of over- or under-transfusion. The concept of early, individualized and goal-directed therapy is explored in this review and the AUVA Trauma Hospital algorithm for managing trauma-induced coagulopathy is presented.
Available from: PubMed Central
- "Development of early coagulopathy after trauma is an independent predictor of poor outcome. Growing recognition of early coagulopathy after injury has led to renewed emphasis on early blood product administration in the injured patient with bleeding[101,102]. "
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ABSTRACT: There is renewed interest in blood product use for resuscitation stimulated by recent military experience and growing recognition of the limitations of large-volume crystalloid resuscitation.
An editorial review of recent reports published by investigators from the United States and Europe is presented. There is little prospective data in this area.
Despite increasing sophistication of trauma care systems, hemorrhage remains the major cause of early death after injury. In patients receiving massive transfusion, defined as 10 or more units of packed red blood cells in the first 24 hours after injury, administration of plasma and platelets in a ratio equivalent to packed red blood cells is becoming more common. There is a clear possibility of time dependent enrollment bias. The early use of multiple types of blood products is stimulated by the recognition of coagulopathy after reinjury which may occur as many as 25% of patients. These patients typically have large-volume tissue injury and are acidotic. Despite early enthusiasm, the value of administration of recombinant factor VIIa is now in question. Another dilemma is monitoring of appropriate component administration to control coagulopathy.
In patients requiring large volumes of blood products or displaying coagulopathy after injury, it appears that early and aggressive administration of blood component therapy may actually reduce the aggregate amount of blood required. If recombinant factor VIIa is given, it should be utilized in the fully resuscitated patient. Thrombelastography is seeing increased application for real-time assessment of coagulation changes after injury and directed replacement of components of the clotting mechanism.
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