Massive Transfusion in Multi-trauma Patients

Introduction: Trauma is not only the leading cause of death in patients under 45 years of age, but also the most common cause for massive transfusion. Adequate recognition of the need for massive transfusion is paramount to decrease early mortality. Massive transfusion protocols have been developed to simplify and standardize transfusion administration are based on prevention of coagulopathy, acidosis and hypothermia. Transfusion not only refers to administering packed red blood cells (PRBC), but also limiting coagulopathy by means of using essential hemostatic blood products, such as fresh frozen plasma (FFP) and platelets (PLT). Case Series: In this article, current opinions on massive transfusion will be discussed, based on three patients who received massive transfusion after major injury. All of the three described patients in this article developed coagulopathy, acidosis and hypothermia. Their physiology was corrected by a combination of damage control surgery and early hemostatic blood transfusion. The two surviving patients did not develop any septic complications caused by massive transfusion. At our institution, a 1:1:1 ratio of PRBC:FFP:PLT is advocated, in concordance with most current literature. Massive transfusion, however, can lead to complications such as transfusion induced lung injury, acute respiratory distress syndrome and multiple organ dysfunction syndrome. Conclusion: In this article, current literature is reviewed, and new insights regarding coagulation measurements and hemostatic products including the influence of transfusion on the immune system have been discussed.

並列關鍵字

Multi-trauma ； Coagulopathy ； Acidosis ； Hypothermia ； Massive transfusion

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