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Empiric transfusion strategies during life-threatening hemorrhage.
Nunns, Geoffrey R; Moore, Ernest E; Stettler, Gregory R; Moore, Hunter B; Ghasabyan, Arsen; Cohen, Mitchell; Huebner, Benjamin R; Silliman, Christopher C; Banerjee, Anirban; Sauaia, Angela.
Afiliação
  • Nunns GR; University of Colorado School of Medicine Department of Surgery, Aurora, CO.
  • Moore EE; University of Colorado School of Medicine Department of Surgery, Aurora, CO; Denver Health Medical Center, Denver, CO. Electronic address: ernest.moore@dhha.org.
  • Stettler GR; University of Colorado School of Medicine Department of Surgery, Aurora, CO.
  • Moore HB; University of Colorado School of Medicine Department of Surgery, Aurora, CO.
  • Ghasabyan A; Denver Health Medical Center, Denver, CO.
  • Cohen M; University of Colorado School of Medicine Department of Surgery, Aurora, CO; Denver Health Medical Center, Denver, CO.
  • Huebner BR; University of Colorado School of Medicine Department of Surgery, Aurora, CO.
  • Silliman CC; University of Colorado School of Medicine Department of Surgery, Aurora, CO; University of Colorado School of Medicine Department of Pediatrics, Aurora, CO; Bonfils Blood Center, Denver, CO.
  • Banerjee A; University of Colorado School of Medicine Department of Surgery, Aurora, CO.
  • Sauaia A; University of Colorado School of Medicine Department of Surgery, Aurora, CO; University of Colorado School of Public Health, Aurora, CO.
Surgery ; 164(2): 306-311, 2018 08.
Article em En | MEDLINE | ID: mdl-29709368
BACKGROUND: Resuscitation guided by thrombelastography improves survival after injury. If bleeding is rapid, however, or if no thrombelastography data are available, the optimal strategy remains controversial. Our current practice gives fresh frozen plasma and red blood cells (1:2) empirically in patients with life-threatening hemorrhage, with subsequent administration based on rapid thrombelastography. We identified patients at risk of massive transfusion at 1 hour, examined their initial rapid thrombelastography, and used this value to provide empiric recommendations about transfusions. METHODS: Massive transfusion was defined as >4 units of red blood cells in the first hour. Patients managed by a trauma activation (2014-2017) had an admission rapid thrombelastography analyzed to determine what proportion met thresholds for administration of cryoprecipitate or platelets. RESULTS: Overall, 35 patients received >4 units of red blood cells in the first hour. Based on the admission rapid thrombelastography, 37% met criteria for both platelets and cryoprecipitate, 35% for either platelets or cryoprecipitate and 29% for neither. Kaplan-Meier analysis showed a significant delay in the administration of cryoprecipitate and platelets compared to fresh frozen plasma. CONCLUSION: Patients who require >4 units of red blood cells within the first hour should receive cryoprecipitate and platelets if thrombelastography results are not available. Point-of-care devices are needed for optimal care of trauma-induced-coagulopathy, but these data offer guidance in their absence.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Transfusão de Sangue / Hemorragia Tipo de estudo: Etiology_studies / Guideline / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Female / Humans / Male / Middle aged País/Região como assunto: America do norte Idioma: En Revista: Surgery Ano de publicação: 2018 Tipo de documento: Article País de publicação: Estados Unidos
Texto completo
Adicionar na Minha BVS
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Transfusão de Sangue / Hemorragia Tipo de estudo: Etiology_studies / Guideline / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Female / Humans / Male / Middle aged País/Região como assunto: America do norte Idioma: En Revista: Surgery Ano de publicação: 2018 Tipo de documento: Article País de publicação: Estados Unidos