Targeted Coagulation Management in Severe Trauma
| Autor: | James Winearls, Don Campbell, Helen Miles, John F. Fraser, Michael C. Reade, Klaus Görlinger, Andrew C. Bulmer |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
medicine.medical_specialty
Population Medizin Hemorrhage 030204 cardiovascular system & hematology Severity of Illness Index Traumatic Hemorrhage 03 medical and health sciences 0302 clinical medicine Blood Substitutes Blood product Severity of illness Coagulopathy Humans Medicine Blood Transfusion Disease management (health) Intensive care medicine education Blood Coagulation Cause of death education.field_of_study business.industry Disease Management 030208 emergency & critical care medicine Blood Coagulation Disorders medicine.disease Anesthesiology and Pain Medicine Severe trauma Wounds and Injuries business |
| Zdroj: | Anesthesia & Analgesia. 123:910-924 |
| ISSN: | 0003-2999 |
| Popis: | Hemorrhage in the setting of severe trauma is a leading cause of death worldwide. The pathophysiology of hemorrhage and coagulopathy in severe trauma is complex and remains poorly understood. Most clinicians currently treating trauma patients acknowledge the presence of a coagulopathy unique to trauma patients-trauma-induced coagulopathy (TIC)-independently associated with increased mortality. The complexity and incomplete understanding of TIC has resulted in significant controversy regarding optimum management. Although the majority of trauma centers utilize fixed-ratio massive transfusion protocols in severe traumatic hemorrhage, a widely accepted "ideal" transfusion ratio of blood to blood products remains elusive. The recent use of viscoelastic hemostatic assays (VHAs) to guide blood product replacement has further provoked debate as to the optimum transfusion strategy. The use of VHA to quantify the functional contributions of individual components of the coagulation system may permit targeted treatment of TIC but remains controversial and is unlikely to demonstrate a mortality benefit in light of the heterogeneity of the trauma population. Thus, VHA-guided algorithms as an alternative to fixed product ratios in trauma are not universally accepted, and a hybrid strategy starting with fixed-ratio transfusion and incorporating VHA data as they become available is favored by some institutions. We review the current evidence for the management of coagulopathy in trauma, the rationale behind the use of targeted and fixed-ratio approaches and explore future directions. |
| Databáze: | OpenAIRE |
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