Features  |   April 2013
Trauma-Induced Coagulopathy and Role of a Massive Transfusion Protocol in Trauma Anesthesia
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Coagulation and Transfusion / Hematologic System / Trauma / Burn Care / Features
Features   |   April 2013
Trauma-Induced Coagulopathy and Role of a Massive Transfusion Protocol in Trauma Anesthesia
ASA Monitor 04 2013, Vol.77, 20-21.
ASA Monitor 04 2013, Vol.77, 20-21.
The treatment of shock after trauma requires a systematic approach to rapidly and accurately diagnose injuries and institute therapy. Definitive control of hemorrhage is essential, together with restoration of adequate circulating blood volume. Use of a massive transfusion protocol (MTP) facilitates rapid availability of components in an increased ratio of plasma and platelets to packed red blood cells (RBCs). The PROPPR study (Pragmatic Randomized Optimal Platelet and Plasma Ratios) is investigating 1:1:1 versus 1:1:2 ratios of Plasma:Platelet:RBC products given to trauma patients who are predicted to require massive transfusions cetir-tmc.org/research/proppr. Point-of-care viscoelastic assays may allow for goal-directed therapy in trauma-induced coagulopathy (TIC) and massive transfusion, including the use of antifibrinolytics when appropriate. Unresolved issues remain, including use of fibrinogen and/or prothrombin complex concentrate, MTP use in blunt versus penetrating trauma, optimal transfusion ratios, and timing of blood component administration. Understanding the mechanism of hemorrhage is clearly required in order to provide optimal treatment. The Trans-Agency Research Consortium for Trauma-Induced Coagulopathy (TACTIC) may help in this regard www.grants.gov/search/search.do?mode=VIEW&oppId=207954. Further information regard-ing MTP, plasma, platelets, additional plasma derivatives and RBC transfusion is available from the ASA Committee on Blood Management www.asahq.org/for-members/about-asa/asa-committees/committee-on-blood-management.aspx.
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