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Hematologic Challenges in the Critically Ill pp 103–125Cite as

Hematologic Advances in Trauma Resuscitation

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Abstract

A significant hematologic challenge in trauma patients is the treatment of hemorrhage and hemorrhagic shock. Trauma patients with major hemorrhage have a 25% mortality in the most recent studies. Hemorrhagic shock is the leading cause of preventable mortality in both military and civilian trauma. Trauma-induced coagulopathy occurs early after injury and results in increased hemorrhage and increased mortality. We have a greater understanding of the mechanisms underlying trauma-induced coagulopathy, with hypoperfusion and increased injury severity inducing protein C activation and hyperfibrinolysis. Both hyperfibrinolysis and fibrinolysis shutdown are associated with increased mortality in trauma. We have achieved significant advances in trauma resuscitation, with the use of guideline-based recommendations for damage control resuscitation using early fixed-ratio 1:1:1 or 1:1:2 blood component ratios, early prompt hemorrhage control, massive transfusion protocols, and viscoelastic testing to guide further trauma resuscitation. We still have significant challenges related to which patients benefit from tranexamic acid administration and the need for additional studies to gain full mechanistic understanding of trauma-induced coagulopathy.

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Authors and Affiliations

  1. Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USA

    Lena M. Napolitano MD, FACS, FCCP, MCCM

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  1. Lena M. Napolitano MD, FACS, FCCP, MCCM
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Correspondence to Lena M. Napolitano MD, FACS, FCCP, MCCM .

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  1. Department of Anesthesiology, Critical Care and Hyperbaric Medicine, Team Health Research Institute, Englewood, NJ, USA

    Aryeh Shander

  2. Department of Critical Care Medicine, Geisinger Health System, Danville, PA, USA

    Howard L. Corwin

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Napolitano, L.M. (2018). Hematologic Advances in Trauma Resuscitation. In: Shander, A., Corwin, H. (eds) Hematologic Challenges in the Critically Ill. Springer, Cham. https://doi.org/10.1007/978-3-319-93572-0_6

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