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Hypovolemic Shock and Massive Transfusion

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Abstract

Hypovolemic shock occurs when the volume within the circulatory system becomes depleted to the extent that tissue perfusion becomes inadequate. In asanguineous hypovolemic shock, effective management is based on:

  1. 1.

    Establishing adequate intravenous or intraosseous access

  2. 2.

    Administering fluids to replete losses and improve cardiac output

  3. 3.

    Monitoring fluid responsiveness

  4. 4.

    Considering the use of vasopressors as a bridge while volume is infused, and titrating off as the volume deficit is overcome

  5. 5.

    Tracking endpoints of resuscitation.

Hemorrhagic shock refers to hypovolemic shock secondary to acute blood loss (sanguineous). Principles of management incorporate those for asanguineous losses, but also include:

  1. 1.

    Expedited source control of bleeding

  2. 2.

    Damage control surgery if operative intervention is indicated

  3. 3.

    Transfusion of blood products utilizing institutional massive transfusion algorithms

  4. 4.

    Permissive hypotension

  5. 5.

    Correction and reversal of factors augmenting shock

  6. 6.

    Minimizing crystalloid administration

  7. 7.

    Administering antifibrinolytics when indicated.

The ideal transfusion ratio of red blood cells to fresh frozen plasma to platelets to best approximate whole blood remains an area of active research, though evidence for a 1:1:1 ratio continues to accumulate. Point-of-care monitoring of the hemostatic system can enable goal-directed transfusion after initial stabilization. Underlying comorbidities and associated injuries should be considered when determining hemodynamic goals of resuscitation; however, existing recommendations (i.e. target blood pressure in head injury) are based off expert consensus in the absence of randomized control trials.

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Author information

Authors and Affiliations

  1. Division of Emergency Critical Care, Department of Emergency Medicine, University of Michigan Health System, Ann Arbor, MI, USA

    Nathan L. Haas & Benjamin S. Bassin

  2. Department of Emergency Medicine, University of Wisconsin, Madison, WI, USA

    Joshua M. Glazer

  3. Division of Emergency Critical Care, Department of Emergency Medicine, Internal Medicine and Anesthesiology, University of Michigan Health System, Ann Arbor, MI, USA

    Kyle J. Gunnerson

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  1. Nathan L. Haas
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  2. Joshua M. Glazer
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  3. Kyle J. Gunnerson
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  4. Benjamin S. Bassin
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Corresponding author

Correspondence to Nathan L. Haas .

Editor information

Editors and Affiliations

  1. Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, MI, USA

    Robert C. Hyzy

  2. Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, MI, USA

    Jakob McSparron

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Haas, N.L., Glazer, J.M., Gunnerson, K.J., Bassin, B.S. (2020). Hypovolemic Shock and Massive Transfusion. In: Hyzy, R.C., McSparron, J. (eds) Evidence-Based Critical Care. Springer, Cham. https://doi.org/10.1007/978-3-030-26710-0_4

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  • DOI: https://doi.org/10.1007/978-3-030-26710-0_4

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