BLOOD MANAGEMENT IN TRAUMATIC RESUSCITATION

Öz

Trauma related hemorrhage ranks among the top preventable causes of death. Traumatic coagulopathy, observed in approximately one-third of patients with hemorrhage, contributes to increased mortality rates.To effectively manage bleeding and promptly administer appropriate blood products, a systematic approach is essential. Implementing pre-hospital restrictive fluid therapy, antifibrinolytic treatment, and targeted blood product administration based on post-admission laboratory tests enhances the chances of successful outcomes. This review aims to provide insights into the recognition of major bleeding and the appropriate administration of blood products, guided by current evidence.

Anahtar Kelimeler

• Trauma
• Trauma induced coagulopathy
• Blood transfusion

TRAVMATİK RESÜSİTASYONDA KAN YÖNETİMİ

Öz

Travmaya bağlı hemoraji, önlenebilir ölümler arasında ilk sıralarda yer almaktadır. Kan kaybıyla birlikte hastaların 1/3’ünde görülebilen travmatik koagülopati mortalite oranlarını artırmaktadır. Kanamanın kontrol altına alınmasıyla birlikte hızlı ve uygun kan ürünlerinin verilmesini sağlayabilmek için sistematik bir yaklaşım gerekmektedir. Hastane öncesi kısıtlayıcı sıvı tedavisi, antifibrinolitik tedavi, hastaneye kabul sonrası laboratuar testleriyle hedefe yönelik kan ürünlerinin uygulanması başarı şansını artırmaktadır. Bu derlemede, majör kanamanın tanınması, uygun laboratuar testleriyle hangi kan ürünlerinin uygulanması gerektiği mevcut kanıtlar eşliğinde aktarılmaya çalışılmıştır.

Anahtar Kelimeler

• Travma
• Travma ilişkili Koagülopati
• Kan Transfüzyonu

Kaynakça

1. Lott C, Truhlář A, Alfonzo A, et al. European Resuscitation Council Guidelines 2021: Cardiac arrest in special circumstances. Resuscitation. 2021;161:152-219.
2. Cole E, Weaver A, Gall L, et al. A Decade of Damage Control Resuscitation: New Transfusion Practice, New Survivors, New Directions. Ann Surg. 2021;273(6):1215-1220.
3. Rossaint, R., Afshari, A., Bouillon, B, et al. The European guideline on management of major bleeding and coagulopathy following trauma: sixth edition. Crit Care. 2023;27(1):80.
4. Mutschler M, Nienaber U, Brockamp T, et al. A critical reappraisal of the ATLS classification of hypovolaemic shock: does it really reflect clinical reality? Resuscitation. 2013;84(3):309-13.
5. El-Menyar A, Goyal P, Tilley E, Latifi R. The clinical utility of shock index to predict the need for blood transfusion and outcomes in trauma. J Surg Res. 2018;227:52-59.
6. Priestley EM, Inaba K, Byerly S, et al. Pulse Pressure as an Early Warning of Hemorrhage in Trauma Patients. J Am Coll Surg. 2019;229(2):184-191.
7. Bickell WH, Wall MJ Jr, Pepe PE, et al. Immediate versus delayed fluid resuscitation for hypotensive patients with penetrating torso injuries. N Engl J Med. 1994;331(17):1105-9.
8. Tran A, Yates J, Lau A, Lampron J, Matar M. Permissive hypotension versus conventional resuscitation strategies in adult trauma patients with hemorrhagic shock: A systematic review and meta-analysis of randomized controlled trials. J Trauma Acute Care Surg. 2018;84(5):802-808.

9. Safiejko K, Smereka J, Filipiak KJ, et al. Effectiveness and safety of hypotension fluid resuscitation in traumatic hemorrhagic shock: A systematic review and meta-analysis of randomized controlled trials. Cardiol J. 2022;29(3):463-471.
10. Wang CH, Hsieh WH, Chou HC, et al. Liberal versus restricted fluid resuscitation strategies in trauma patients: a systematic review and meta-analysis of randomized controlled trials and observational studies. Crit Care Med. 2014;42(4):954-61.
11. Kasotakis G, Sideris A, Yang Y, et al. Aggressive early crystalloid resuscitation adversely affects outcomes in adult blunt trauma patients: an analysis of the Glue Grant database. J Trauma Acute Care Surg. 2013;74(5):1215-21.
12. Gauss T, Gayat E, Harrois A, et al Effect of early use of noradrenaline on in-hospital mortality in haemorrhagic shock after major trauma: a propensity-score analysis. Br J Anaesth. 2018;120(6):1237-1244.
13. Tseng CH, Chen TT, Wu MY, Chan MC, Shih MC, Tu YK. Resuscitation fluid types in sepsis, surgical, and trauma patients: a systematic review and sequential network meta-analyses. Crit Care. 2020;24(1):693.
14. Smith IM, James RH, Dretzke J, Midwinter MJ. Prehospital Blood Product Resuscitation for Trauma: A Systematic Review. Shock. 2016;46(1):3-16.
15. Sperry JL, Guyette FX, Adams PW et al. Prehospital Plasma during Air Medical Transport in Trauma Patients. N Engl J Med. 2018;379(18):1783.
16. Moore HB, Moore EE, Chapman MP, et al. Plasma-first resuscitation to treat haemorrhagic shock during emergency ground transportation in an urban area: a randomised trial. Lancet. 2018;392(10144):283-291.
17. Pusateri AE, Moore EE, Moore HB, et al. Association of Prehospital Plasma Transfusion With Survival in Trauma Patients With Hemorrhagic Shock When Transport Times Are Longer Than 20 Minutes: A Post Hoc Analysis of the PAMPer and COMBAT Clinical Trials. JAMA Surg. 2020;155(2):e195085.
18. Crombie N, Doughty HA, Bishop JRB, et al. Resuscitation with blood products in patients with trauma-related haemorrhagic shock receiving prehospital care (RePHILL): a multicentre, open-label, randomised, controlled, phase 3 trial. Lancet Haematol. 2022;9(4):e250-e261.
19. Moore EE, Moore HB, Kornblith LZ, et al. Trauma-induced coagulopathy. Nat Rev Dis Primers. 2021;7(1):30.
20. Borgman MA, Spinella PC, Perkins JG, et al. The ratio of blood products transfused affects mortality in patients receiving massive transfusions at a combat support hospital. J Trauma. 2007;63(4):805-13.
21. Holcomb JB, del Junco DJ, Fox EE, et al. The prospective, observational, multicenter, major trauma transfusion (PROMMTT) study: comparative effectiveness of a time-varying treatment with competing risks. JAMA Surg. 2013;148(2):127-36.
22. 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(5):471-82
23. Hilbert-Carius P, Hofmann G, Stuttmann R. Hemoglobin-oriented and coagulation factor-based algorithm : Effect on transfusion needs and standardized mortality rate in massively transfused trauma patients]. Anaesthesist. 2015;64(11):828-38.
24. Veigas PV, Callum J, Rizoli S, Nascimento B, da Luz LT. A systematic review on the rotational thrombelastometry (ROTEM®) values for the diagnosis of coagulopathy, prediction and guidance of blood transfusion and prediction of mortality in trauma patients. Scand J Trauma Resusc Emerg Med. 2016;24(1):114.
25. Sayce AC, Neal MD, Leeper CM. Viscoelastic monitoring in trauma resuscitation. Transfusion. 2020;60 Suppl 6:S33-S51.
26. Gonzalez E, Moore EE, Moore HB, et al. Goal-directed Hemostatic Resuscitation of Trauma-induced Coagulopathy: A Pragmatic Randomized Clinical Trial Comparing a Viscoelastic Assay to Conventional Coagulation Assays. Ann Surg. 2016;263(6):1051-9.
27. Baksaas-Aasen K, Gall LS, Stensballe J, et al. Viscoelastic haemostatic assay augmented protocols for major trauma haemorrhage (ITACTIC): a randomized, controlled trial. Intensive Care Med. 2021;47(1):49-59.
28. Hanna M, Knittel J, Gillihan J. The Use of Whole Blood Transfusion in Trauma. Curr Anesthesiol Rep. 2022;12(2):234-239.
29. Ngatuvai M, Zagales I, Sauder M, et al. Outcomes of Transfusion With Whole Blood, Component Therapy, or Both in Adult Civilian Trauma Patients: A Systematic Review and Meta-Analysis. J Surg Res. 2023;287:193-201.
30. Shakur H, Roberts I, Bautista R, et al. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet. 2010;376(9734):23-32.
31. CRASH-3 trial collaborators. Effects of tranexamic acid on death, disability, vascular occlusive events and other morbidities in patients with acute traumatic brain injury (CRASH-3): a randomised, placebo-controlled trial. Lancet. 2019;394(10210):1713-1723.
32. Gruen RL, Mitra B, Bernard SA, et al. Prehospital Tranexamic Acid for Severe Trauma. N Engl J Med. 2023;389(2):127-136.
33. Matthay ZA, Fields AT, Nunez-Garcia B, et al. Dynamic effects of calcium on in vivo and ex vivo platelet behavior after trauma. J Trauma Acute Care Surg. 2020;89(5):871-879.
34. Magnotti LJ, Bradburn EH, Webb DL, et al. Admission ionized calcium levels predict the need for multiple transfusions: a prospective study of 591 critically ill trauma patients. J Trauma. 2011;70(2):391-5.
35. Levi M, Levy JH, Andersen HF, Truloff D. Safety of recombinant activated factor VII in randomized clinical trials. N Engl J Med. 2010;363(19):1791-800.
36. Connolly SJ, Milling TJ Jr, Eikelboom JW, et al. Andexanet Alfa for Acute Major Bleeding Associated with Factor Xa Inhibitors. N Engl J Med. 2016;375(12):1131-41.
37. Pollack CV Jr, Reilly PA, Eikelboom J, et al. Idarucizumab for Dabigatran Reversal. N Engl J Med. 2015;373(6):511-20.
38. Kakkos S, Kirkilesis G, Caprini JA, et al. Combined intermittent pneumatic leg compression and pharmacological prophylaxis for prevention of venous thromboembolism. Cochrane Database Syst Rev. 2022;1(1):CD005258.