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Blood Transfusion in the Severe Trauma Patient

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Essentials of Blood Product Management in Anesthesia Practice

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Abstract

The strategy of damage control resuscitation for a trauma patient in hemorrhagic shock involves preserving end-organ perfusion and preventing any further progression of the lethal triad of death; hypothermia, acidosis, and coagulopathy, which is commonly associated with hemorrhagic shock (Schreiber, Care Crit Curr Opin 11:590, 2005). Trauma patients are treated with surgical maneuvers to control bleeding, pharmacologic therapies to reduce bleeding, and by replacement of lost blood volume with blood products.

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References

  1. Schreiber MA. Coagulopathy in the trauma patient. Curr Opin Crit Care. 2005;11:590.

    Article  PubMed  Google Scholar 

  2. American College of Surgeons Committee on Trauma. ATLS advanced trauma life support student course manual. 10th ed. Chicago: American College of Surgeons; 2018.

    Google Scholar 

  3. Moore EE, Feliciano DV, Mattox KL. Trauma. 8th ed. New York: McGraw-Hill; 2017.

    Google Scholar 

  4. Duchesne JC, Heaney J, Guidry C, et al. Diluting the benefits of hemostatic resuscitation: a multi-institutional analysis. J Trauma Acute Care Surg. 2013;751:76.

    Article  Google Scholar 

  5. Holcomb JB, Tilley BC, Baraniuk S, et al. Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma: the PROPPR randomized clinical trial. JAMA. 2015;313:471.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Kornblith LZ, Howard BM, Cheung CK, et al. The whole is greater than the sum of its parts: hemostatic profiles of whole blood variants. J Trauma Acute Care Surg. 2014;77:818.

    Article  CAS  PubMed  Google Scholar 

  7. Cannon JW, Khan MA, Raja AS, et al. Damage control resuscitation in patients with severe traumatic hemorrhage: a practice management guideline from the Eastern Association for the surgery of trauma. J Trauma Acute Care Surg. 2017;82:605.

    Article  PubMed  Google Scholar 

  8. Roberts I. Tranexamic acid in trauma: how should we use it? J Thromb Haemost. 2015;13(Suppl. 1):S195–S9.

    Article  CAS  PubMed  Google Scholar 

  9. Takada A, Makino Y, Takada Y. Effects of tranexamic acid on fibrinolysis, fibrinogenolysis and amidolysis. Thromb Res. 1986;42:39–47.

    Article  CAS  PubMed  Google Scholar 

  10. Ker K, Edwards P, Perel P, Shakur H, Roberts I. Effect of tranexamic acid on surgical bleeding: systematic review and cumulative meta-analysis. BMJ. 2012;344:e3054.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  11. Ker K, Prieto-Merino D, Roberts I. Systematic review, meta-analysis and meta-regression of the effect of tranexamic acid on surgical blood loss. B J Surg. 2013;100:1271–9.

    Article  CAS  Google Scholar 

  12. Roberts I, Shakur H, Coats T, et al. The CRASH-2 trial: a randomized controlled trial and economic evaluation of the effects of tranexamic acid on death, vascular occlusive events and transfusion requirement in bleeding trauma patients. Health Technol Assess. 2013;17(10):1–79. https://doi.org/10.3310/hta17100.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. CRASH-2 Collaborators I, Roberts HS, Afolabi A, et al. The importance of early treatment with tranexamic acid in bleeding trauma patients: an exploratory analysis of the CRASH-2 randomized controlled trial. Lancet. 2011;377(9771):1096–101. 21439633.

    Article  CAS  Google Scholar 

  14. Roberts I, Pablo P, David P-M, Haleema S, Tim C, Hunt Beverley J, et al. Effect of tranexamic acid on mortality in patients with traumatic bleeding: prespecified analysis of data from randomized controlled trial. BMJ. 2012;345:e5839.

    Article  PubMed  PubMed Central  Google Scholar 

  15. “Lysteda (tranexamic acid) Package Insert” (PDF). accessdata.FDA.gov. Retrieved 20 June 2019.

  16. Kauvar DS, Lefering R, Wade CE. Impact of hemorrhage on trauma outcome: an overview of epidemiology, clinical presentations, and therapeutic considerations. J Trauma. 2006;60(6 Suppl):S3–11.

    PubMed  Google Scholar 

  17. Perez P, Salmi LR, Folléa G, Schmit JL, de Barbeyrac B, Sudre P, Salamon R, BACTHEM Group. French haemovigilance network. Determinants of transfusion-associated bacterial contamination: results of the French BACTHEM case-control study. Transfusion. 2001 Jul;41(7):862–72.

    Article  CAS  PubMed  Google Scholar 

  18. Williamson LM, Lowe S, Love EM, Cohen H, Soldan K, McClelland DB, Skacel P, Barbara JA. Serious hazards of transfusion (SHOT) initiative: analysis of the first two annual reports. BMJ. 1999;319(7201):16–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Kuehnert MJ, Roth VR, Haley NR, Gregory KR, Elder KV, Schreiber GB, Arduino MJ, Holt SC, Carson LA, Banerjee SN, Jarvis WR. Transfusion-transmitted bacterial infection in the United States, 1998 through 2000. Transfusion. 2001;41(12):1493–9.

    Article  CAS  PubMed  Google Scholar 

  20. Menis M, Forshee RA, Anderson SA, McKean S, Gondalia R, Warnock R, Johnson C, Mintz PD, Worrall CM, Kelman JA, Izurieta HS. Febrile non-haemolytic transfusion reaction occurrence and potential risk factors among the U.S. elderly transfused in the inpatient setting, as recorded in Medicare databases during 2011-2012. Vox Sang. 2015 Apr;108(3):251–61.

    Article  CAS  PubMed  Google Scholar 

  21. Blundell J. Experiments on the transfusion of blood by the syringe. Med Chir Trans. 1818;9(Pt 1):56–92.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Highmore W. Practical remarks on an overlooked source of blood supply for transfusion in post-partum haemorrhage suggested by a recent fatal case. Lancet. 1874;103:89–90.

    Article  Google Scholar 

  23. Halsted WS. Refusion in carbonic-oxide poisoning. New York J Med. 1883;38:625–9.

    Google Scholar 

  24. Duncan J. On re-infusion of blood in primary and other amputations. Br Med J. 1886;1:192–3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Thies HJ. Zur Behandlung der Extrauteringravidität. Zentralbl Gynäkol. 1914;38:1191–3.

    Google Scholar 

  26. Griswald RA, Ortner AB. Use of autotransfusion in surgery of serous cavities. Surg Gynecol Obstet. 1943;77:167–77.

    Google Scholar 

  27. Klebanoff G. Early clinical experience with a disposable unit for the intraoperative salvage and reinfusion of blood loss (intraoperative autotransfusion). Am J Surg. 1970;120:718–22.

    Article  CAS  PubMed  Google Scholar 

  28. Wilson JD, Taswell HF. Autotransfusion: historical review and preliminary report on a new method. Mayo Clin Proc. 1968;43(1):26–35.

    CAS  PubMed  Google Scholar 

  29. Carless PA, Henry DA, Moxey AJ, O'Connell D, Brown T, Fergusson DA. Cell salvage for minimizing perioperative allogeneic blood transfusion. Cochrane Database Syst Rev. 2010;4:CD001888.

    Google Scholar 

  30. Garcia JH, Coelho GR, Feitosa Neto BA, Nogueira EA, Teixeira CC, Mesquita DF. Liver transplantation in Jehovah’s witnesses patients in a center of northeastern Brazil. Arq Gastroenterol. 2013;50(2):138–40.

    Article  PubMed  Google Scholar 

  31. Waters JH. Indications and contraindications of cell salvage. Transfusion. 2004;44(12 Suppl):40S–4S.

    Article  PubMed  Google Scholar 

  32. Esper SA, Waters JH. Intra-operative cell salvage: a fresh look at the indications and contraindications. Blood Transfus. 2011;9(2):139–47.

    PubMed  PubMed Central  Google Scholar 

  33. Sikorski RA, Rizkalla NA, Yang WW, Frank SM. Autologous blood salvage in the era of patient blood management. Vox Sang. 2017;112:499–510.

    Article  CAS  PubMed  Google Scholar 

  34. White NJ. Mechanism of trauma-induced coagulopathy. Hematology Am Soc Hematol Educ Program. 2013;2013:660–3.

    Article  PubMed  Google Scholar 

  35. Mohamed, et al. Scand J Trauma Resusc Emerg Med 2017: 25:99.

    Google Scholar 

  36. Adelfattah K, Cripps MW. Thromboelastography and rotational thromboelastometry use in trauma. Int J Surg. 2016;33:196–201.

    Article  Google Scholar 

  37. Brohi K, Singh J, Heron M, Coats T. Acute traumatic coagulopathy. J Trauma Acute Care Surg. 2003; Jun 1;54(6):1127–30.

    Article  Google Scholar 

  38. Khan S, Brohi K, Chana M, Raza I, Stanworth S, Gaarder C, Davenport R. Hemostatic resuscitation is neither hemostatic nor resuscitative in trauma hemorrhage. J Trauma Acute Care Surg. 2014;76(3):561–8.

    Article  CAS  PubMed  Google Scholar 

  39. Howley IW, Haut ER, Jacobs L, et al. Is thromboelastography (TEG)-based resucitation better than empirical 1:1 transfusion? Trauma Surg Acute Care Open. 2018;3:1–3.

    Google Scholar 

  40. Schochl H, Maegele M, Solomnon C, Gorlinger K, Voelckel W. Early and individualized goal-directed therapy for trauma induced coagulopathy. Scand J Trauma Resusc Emerg Med. 2012;20:15.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Kashuk J, Moore E, Sawyer M, et al. Post injury coagulopathy management: goal directed resuscitation via POC thromboelastography. Ann Surg. 2010;251(4):604–14.

    Article  PubMed  Google Scholar 

  42. Massaro A, Doerfler S, Nawalinski K, et al. Thromboelastography defines late hypercoagulability after TBI: a pilot study. Neurocrit Care. 2015;22:45–51.

    Article  PubMed  Google Scholar 

  43. Mitra B, Cameron P, Gruen R. Aggressive fresh frozen plasma (FFP) with massive blood transfusion in the absence of acute traumatic coagulopathy. Injury. 2012;43(1):33–7.

    Article  PubMed  Google Scholar 

  44. Gruen R, Jacobs I, Reade M. Trauma and tranexamic acid. Med J Aus. 2013;199(5):310–1.

    Article  Google Scholar 

  45. Walsh M, Fritz S, Hake D, Son M, et al. Targeted Thromboelastographic (TEG) blood component and pharmacologic hemostatic therapy in traumatic and acquired coagulopathy. Curr Drug Targets. 2016;17:954–70.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Benson AB, Moss M, Silliman CC. Transfusion-related acute lung injury (TRALI): a clinical review with emphasis on the critically ill. Br J Haematol. 2009;147:431.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Meyer DE, Reynolds JW, Hobbs R, et al. The incidence of transfusion-related acute lung injury at a large, Urban Tertiary Medical Center: a decade’s experience. Anesth Analg. 2018;127:444.

    Article  PubMed  Google Scholar 

  48. Patel SV, Kidane B, Klingel M, et al. Risks associated with red blood cell transfusion in the trauma population, a meta-analysis. Injury. 2014;45:1522.

    Article  PubMed  Google Scholar 

  49. Jones AR, Patel RP, Marques MB, et al. Older blood is associated with increased mortality and adverse events in massively transfused trauma patients: secondary analysis of the PROPPR trial. Ann Emerg Med. 2019;73:650.

    Article  PubMed  Google Scholar 

  50. Vraets A, Lin Y, Callum JL. Transfusion-associated hyperkalemia. Transfus Med Rev. 2011;25:184.

    Article  PubMed  Google Scholar 

  51. Sihler KC, Napolitano LM. Complications of massive transfusion. Chest. 2010;137:209.

    Article  PubMed  Google Scholar 

  52. Perlman R, Callum J, Laflamme CA, et al. A recommended early goal-directed management guideline for the prevention of hypothermia-related transfusion, morbidity, and mortality in severely injured trauma patients. Crit Care. 2016;20:107.

    Article  PubMed  PubMed Central  Google Scholar 

  53. ThermaCor 1200 rapid infusion device website. https://www.thermacor1200.com/company-info.cms. Accessed 10 Jul 2019.

  54. Level 1 rapid infusion device website. https://www.smiths-medical.com/products/temperature-management/blood-and-fluid-warming-systems/fast-flow-fluid-warming-trauma/level-1-h1200-fast-flow-fluid-warmer-with-integrated-air-detectorclamp. Accessed 10 Jul 2019.

  55. Belmont rapid infusion device website. http://www.eostip.com/imgs/pdf/pdf_1_10.pdf. Accessed 10 Jul 2019.

  56. Cumunale ME. A laboratory evaluation of the level 1 rapid infuser (H1025) and the Belmont instrument fluid management system (FMS 2000) for rapid transfusion. Anesth Analg. 2003;97:1064–9.

    Article  Google Scholar 

  57. Barcelona SL, Vilich F, Cote CJ. A comparison of flow rates and warming capabilities of the level 1 and rapid infusion system with various-size intravenous catheters. Anes Analg. 2003;97:358–63.

    Article  Google Scholar 

  58. Wrenn EA, Wohlers R, Montgomery M, et al. Comparison of flow dynamics of peripherally and centrally inserted intravenous catheters using a rapid infusion system (ThermaCor1200). AANA. 2017;85(4):256–60.

    Google Scholar 

  59. Buck A. Large bore IV access showdown: do you know which IV cannula can deliver fluid to your patient the fastest? ETM Course. https://etmcourse.com/large-bore-iv-access-showdown/. Accessed 15 Jul 2019.

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Authors and Affiliations

  1. University of Florida – Jacksonville, Department of Anesthesiology, Jacksonville, FL, USA

    Jose C. Humanez, Oladapo Oshikoya & Amie L. Hoefnagel

  2. University of Florida – Jacksonville, Department of Surgery, Jacksonville, FL, USA

    Albert Hsu

Authors
  1. Jose C. Humanez
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  2. Oladapo Oshikoya
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  3. Albert Hsu
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  4. Amie L. Hoefnagel
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Corresponding author

Correspondence to Amie L. Hoefnagel .

Editor information

Editors and Affiliations

  1. NYU-Grossman School of Medicine, Department of Anesthesiology, New York, NY, USA

    Corey S. Scher

  2. Departments of Anesthesiology and Pharmacology Toxicology, and Neurosciences, Louisiana State University School of Medicine-Shreveport, Shreveport, LA, USA

    Alan David Kaye

  3. Department of Anesthesiology and Perioperative Medicine, Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA, USA

    Henry Liu

  4. NYU Grossman School of Medicine, Department of Anesthesiology, Perioperative Care and Pain Medicine, New York, NY, USA

    Seth Perelman

  5. NYU-Grossman School of Medicine, Department of Anesthesiology, New York, NY, USA

    Sarah Leavitt

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Humanez, J.C., Oshikoya, O., Hsu, A., Hoefnagel, A.L. (2021). Blood Transfusion in the Severe Trauma Patient. In: Scher, C.S., Kaye, A.D., Liu, H., Perelman, S., Leavitt, S. (eds) Essentials of Blood Product Management in Anesthesia Practice. Springer, Cham. https://doi.org/10.1007/978-3-030-59295-0_20

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  • DOI: https://doi.org/10.1007/978-3-030-59295-0_20

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  • Online ISBN: 978-3-030-59295-0

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