Comparing hemostatic resuscitation management of intraoperative massive bleeding with traumatic massive bleeding: a computer simulation
| Autor: | Lee, Young Sun, Kim, Kyu Nam, Lee, Min Kyu, Sun, Jung Eun, Lim, Hyun Jin, Jun, Jong Hun |
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| Rok vydání: | 2020 |
| Předmět: |
Blood coagulation disorder
Experimental Research business.industry Hemorrhage 030208 emergency & critical care medicine Blood volume General Medicine Computer simulation 030204 cardiovascular system & hematology Bleed Cardiothoracic and Vascular Anesthesia 03 medical and health sciences Blood component transfusion 0302 clinical medicine Blood pressure Anesthesia Blood Component Transfusion Medicine Platelet Fresh frozen plasma Packed red blood cells business |
| Zdroj: | Anesthesia and Pain Medicine |
| ISSN: | 2383-7977 1975-5171 |
| DOI: | 10.17085/apm.20042 |
| Popis: | Background: Appropriate blood component transfusion might differ between intraoperative massive bleeding and traumatic massive bleeding in the emergency department because trauma patients initially bleed undiluted blood and replacement typically lags behind blood loss. We compared these two blood loss scenarios, intraoperative and traumatic, using a computer simulation.Methods: We modified the multi-compartment dynamic model developed by Hirshberg and implemented it using STELLA 9.0. In this model, blood pressure changes as blood volume fluctuates as bleeding rate and transcapillary refill rate are controlled by blood pressure. Using this simulation, we compared the intraoperative bleeding scenario with the traumatic bleeding scenario. In both scenarios, patients started to bleed at a rate of 50 ml/min. In the intraoperative bleeding scenario, fluid was administered to maintain isovolemic status; however, in the traumatic bleeding scenario, no fluid was supplied for up to 30 min and no blood was supplied for up to 50 min. Each unit of packed red blood cells (PRBC) was given when the hematocrit decreased to 27%, fresh frozen plasma (FFP) was transfused when plasma was diluted to 30%, and platelet concentrate (PC) was transfused when platelet count became 50,000/ml.Results: In both scenarios, the appropriate ratio of PRBC:FFP was 1:0.47 before PC transfusion, and the ratio of PRBC:FFP:platelets was 1:0.35:0.39 after initiation of PC transfusion.Conclusion: The ratio of transfused blood component did not differ between the intraoperative bleeding and traumatic bleeding scenarios. |
| Databáze: | OpenAIRE |
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