Study: Effective Transfusion in Severe Trauma
Around twenty to forty percent of trauma deaths occurring after hospital admission result from massive haemorrhage from an injury to the trunk of the body. These are potentially preventable with rapid haemorrhage control and improved resuscitation techniques. These patients often require massive transfusion. Earlier transfusion with balanced blood product ratios (1:1:1 ratios for plasma, platelets, and red blood cells), defined as “damage control resuscitation”, has been associated with improved outcomes; however, there have been no large multicentre clinical trials, according to the article.
John B. Holcomb, MD, of the University of Texas Health Science Center at Houston, and colleagues conducted a study in which 680 severely injured patients who arrived at 1 of 12 level I trauma centres and were predicted to require massive transfusion were randomly assigned to receive blood product ratios of 1:1:1 for units of plasma to platelets to red blood cells (a ratio that is the closest approximation to reconstituted whole blood), or 1:1:2, during active resuscitation in addition to all local standard interventions. Patients were assigned to one of these component ratios within 8 minutes of calling the blood bank, allowing the rapid delivery and infusion of the predetermined ratios.
The researchers found no significant differences for the primary outcomes of the study: mortality at 24 hours (12.7 percent in 1:1:1 group vs 17.0 percent in 1:1:2 group) or at 30 days (22.4 percent vs 26.1 percent, respectively). Exsanguination (extensive loss of blood), which was the predominant cause of death within the first 24 hours, was significantly decreased in the 1:1:1 group (9.2 percent vs 14.6 percent in 1:1:2 group). More patients in the 1:1:1 group achieved haemostasis than in the 1:1:2 group (86 percent vs 78 percent, respectively).
Despite concerns that the 1:1:1 group would experience higher rates of multiple inflammatory-mediated complications such as acute respiratory distress syndrome, multiple organ failure, infection, blood clots, and sepsis, no differences were detected between the two treatment groups.
“Given the lower percentage of deaths from exsanguination and our failure to find differences in safety, clinicians should consider using a 1:1:1 transfusion protocol, starting with the initial units transfused while patients are actively bleeding, and then transitioning to laboratory-guided treatment once haemorrhage control is achieved. Future studies of haemorrhage control products, devices, and interventions should concentrate on the physiologically relevant period of active bleeding after injury and use acute complications and later deaths (24 hours and 30 days) as safety end points,” the authors write.
Image source: Pixabay
Published on : Tue, 3 Feb 2015
Print as PDF
17 critical parameters from a blood sample as small as 45 µL Not available in the US When the sample is small but your diagnostic needs are big, the ABL90 FLEX PLUS blood gas analyzer provides critical insights with a turnaround time of less than...
Medos hemofilters pro are used for efficient and gentle hemofiltration during extracorporal circulation.Medos hemofilters pro do not need to be pre-flushed and can be used immediately. This guarantees a safe and quick hemofiltration.
NovaPort cannulas: The safe access to the vascular system. NovaPort® twin double lumen cannulas are specifically developed for veno-venous vascular access. NovaPort one single lumen cannulas are specifically developed for the percutaneous connection (KU)...
The HAMILTON-T1 combines for the first time the functionality of a fully featured intensive care unit ventilator with the compactness and ruggedness required for transport. This is why the HAMILTON-T1 enables you to provide optimal ventilation therapy...
The fully featured ICU ventilator, HAMILTON-MR1, guarantees uncompromised continuous ventilation care from the ICU to the MRI scanner and back. Its reliability and high performance, with advanced lung-protective strategies and patient-adaptive modes,...