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Transfusion in the Intensive Care Unit pp 101–119Cite as

Massive Transfusion in Trauma

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Abstract

Transfusion in trauma has undergone a paradigm shift in the past decade. Previous resuscitation strategies for trauma haemorrhage featured early administration of large volumes of crystalloids with subsequent delivery of plasma to treat a gradually evolving coagulopathy due to haemodilution, hypothermia and acidosis. However, the identification of an acute endogenous coagulopathy in trauma victims triggered a re-evaluation of this strategy. Acute traumatic coagulopathy (ATC) occurs rapidly after severe injury as a product of combined tissue damage and hypoperfusion. A series of retrospective observational studies have identified that trauma patients receiving early (and high-dose) administration of haemostatic blood products (including plasma, fibrinogen and platelets), rather than crystalloids, may have better survival with reduced morbidity. This has been attributed to better prevention and/or treatment of ATC. Most western trauma centres now utilise a massive haemorrhage protocol to guide rapid delivery of these blood products in prespecified ratios. However, the re-emergence of thromboelastography is offering promise to refine this formulaic approach and replace it with patient-tailored algorithms. This chapter will describe the recent evolution in trauma transfusion with focus on our developing understanding of the coagulopathy driving these changes.

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Authors and Affiliations

  1. Centre for Trauma Sciences, Queen Mary University of London, London, UK

    Daniel Frith MBBS, MRCS, PhD & Karim Brohi FRCS, FRCA

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  1. Daniel Frith MBBS, MRCS, PhD
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  2. Karim Brohi FRCS, FRCA
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Correspondence to Daniel Frith MBBS, MRCS, PhD .

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  1. Department of Intensive Care L.E.I.C.A., Academic Medical Center, Amsterdam, The Netherlands

    Nicole P. Juffermans

  2. MRC Centre for Inflammation Research, University of Edinburgh The Queens Medical Research Institute, Edinburgh, United Kingdom

    Timothy S. Walsh

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Frith, D., Brohi, K. (2015). Massive Transfusion in Trauma. In: Juffermans, N., Walsh, T. (eds) Transfusion in the Intensive Care Unit. Springer, Cham. https://doi.org/10.1007/978-3-319-08735-1_11

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