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Mortality in civilian trauma patients and massive blood transfusion treated with high vs low plasma: red blood cell ratio. Systematic review and meta-analysis. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2020. [DOI: 10.1097/cj9.0000000000000161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Introduction: Massive bleeding in civilian trauma patients leads to dilutional coagulopathy. Transfusion with high plasma: red blood cell (RBC) ratio has been effective in reducing mortality in war trauma patients. However, in civilian trauma the evidence is controversial.
Objective: To assess the impact on mortality of high vs low plasma: RBC ratio transfusion, in civilian trauma patients with massive bleeding.
Methods: A systematic review and meta-analysis, including observational studies and clinical trials, was conducted. Databases were systemically searched for relevant studies between January 2007 and June 2019. The main outcome was early (24-hours) and late (30-day) mortality. Fixed and random effects models were used.
Results: Out of 1295 studies identified, 33 were selected: 2 clinical trials and 31 observational studies. The analysis of observational trials showed both decreased early mortality (odds ratio [OR] 0.67; 95% confidence interval [CI], 0.60–0.75) and late mortality (OR 0.79; 95% CI, 0.71–0.87) with the use of high plasma:RBC ratio transfusion, but there were no differences when clinical trials were evaluated (OR 0.89; 95% CI, 0.64–1.26). The exclusion of patients who died within the first 24hours was a source of heterogeneity. The Injury Severity Score (ISS) altered the association between high plasma: RBC ratio and mortality, with a reduced protective effect when the ISS was high.
Conclusion: The use of high vs low plasma: RBC ratio transfusion, in patients with massive bleeding due to civil trauma, has a protective effect on early and late mortality in observational studies. The exclusion of patients who died within the first 24 hours was a source of heterogeneity.
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da Luz LT, Shah PS, Strauss R, Mohammed AA, D'Empaire PP, Tien H, Nathens AB, Nascimento B. Does the evidence support the importance of high transfusion ratios of plasma and platelets to red blood cells in improving outcomes in severely injured patients: a systematic review and meta-analyses. Transfusion 2019; 59:3337-3349. [PMID: 31614006 PMCID: PMC6900194 DOI: 10.1111/trf.15540] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 08/13/2019] [Accepted: 08/21/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Deaths by exsanguination in trauma are preventable with hemorrhage control and resuscitation with allogeneic blood products (ABPs). The ideal transfusion ratio is unknown. We compared efficacy and safety of high transfusion ratios of FFP:RBC and PLT:RBC with low ratios in trauma. STUDY DESIGN AND METHODS Medline, Embase, Cochrane, and Controlled Clinical Trials Register were searched. Observational and randomized data were included. Risk of bias was assessed using validated tools. Primary outcome was 24-h and 30-day mortality. Secondary outcomes were exposure to ABPs and improvement of coagulopathy. Meta-analysis was conducted using a random-effects model. Strength and evidence quality were graded using GRADE profile RESULTS: 55 studies were included (2 randomized and 53 observational), with low and moderate risk of bias, respectively, and overall low evidence quality. The two RCTs showed no mortality difference (odds ratio [OR], 1.35; 95% confidence interval [CI], 0.40-4.59). Observational studies reported lower mortality in high FFP:RBCs ratio (OR, 0.38 [95% CI, 0.22-0.68] for 1:1 vs. <1:1; OR, 0.42 [95% CI, 0.22-0.81] for 1:1.5 vs. <1:1.5; and OR, 0.47 [95% CI, 0.31-0.71] for 1:2 vs. <1:2, respectively). Meta-analyses in observational studies showed no difference in exposure to ABPs. No data on coagulopathy for meta-analysis was identified. CONCLUSIONS Meta-analyses in observational studies suggest survival benefit and no difference in exposure to ABPs. No survival benefit in RCTs was identified. These conflicting results should be interpreted with caution. Studies are mostly observational, with relatively small sample sizes, nonrandom treatment allocation, and high potential for confounding. Further research is warranted.
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Affiliation(s)
| | - Prakesh S. Shah
- Department of PediatricsMount Sinai HospitalTorontoOntarioCanada
| | - Rachel Strauss
- Department SurgerySunnybrook Health Sciences CentreTorontoOntarioCanada
| | | | - Pablo Perez D'Empaire
- Department Anesthesia, Sunnybrook Health Sciences CentreUniversity of TorontoTorontoOntarioCanada
| | - Homer Tien
- Department SurgerySunnybrook Health Sciences CentreTorontoOntarioCanada
| | - Avery B. Nathens
- Department SurgerySunnybrook Health Sciences CentreTorontoOntarioCanada
| | - Barto Nascimento
- Department SurgerySunnybrook Health Sciences CentreTorontoOntarioCanada
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3
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Roquet F, Neuschwander A, Hamada S, Favé G, Follin A, Marrache D, Cholley B, Pirracchio R. Association of Early, High Plasma-to-Red Blood Cell Transfusion Ratio With Mortality in Adults With Severe Bleeding After Trauma. JAMA Netw Open 2019; 2:e1912076. [PMID: 31553473 PMCID: PMC6763975 DOI: 10.1001/jamanetworkopen.2019.12076] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
IMPORTANCE Optimal transfusion management is crucial when treating patients with trauma. However, the association of an early, high transfusion ratio of fresh frozen plasma (FFP) to packed red blood cells (PRBC) with survival remains uncertain. OBJECTIVE To study the association of an early, high FFP-to-PRBC ratio with all-cause 30-day mortality in patients with severe bleeding after trauma. DESIGN, SETTING, AND PARTICIPANTS This cohort study analyzes the data included in a multicenter national French trauma registry, Traumabase, from January 2012 to July 2017. Traumabase is a prospective, active, multicenter adult trauma registry that includes all consecutive patients with trauma treated at 15 trauma centers in France. Overall, 897 patients with severe bleeding after trauma were identified using the following criteria: (1) received 4 or more units of PRBC during the first 6 hours or (2) died from hemorrhagic shock before receiving 4 units of PRBC. EXPOSURES Eligible patients were divided into a high-ratio group, defined as an FFP-to-PRBC ratio more than 1:1.5, and a low-ratio group, defined as an FFP-to-PRBC ratio of 1:1.5 or less. The ratio was calculated using the cumulative units of FFP and PRBC received during the first 6 hours of management. MAIN OUTCOMES AND MEASURES A Cox regression model was used to analyze 30-day survival with the transfusion ratio as a time-dependent variable to account for survivorship bias. RESULTS Of the 12 217 patients included in the registry, 897 (7.3%) were analyzed (median [interquartile range] age, 38 (29-54) years; 639 [71.2%] men). The median (interquartile range) injury severity score was 34 (22-48), and the overall 30-day mortality rate was 33.6% (301 patients). A total of 506 patients (56.4%) underwent transfusion with a high ratio and 391 (43.6%) with a low ratio. A high transfusion ratio was associated with a significant reduction in 30-day mortality (hazard ratio, 0.74; 95% CI, 0.58-0.94; P = .01). When only analyzing patients who had complete data, a high transfusion ratio continued to be associated with a reduction in 30-day mortality (hazard ratio, 0.57; 95% CI, 0.33-0.97; P = .04). CONCLUSIONS AND RELEVANCE In this analysis of the Traumabase registry, an early FFP-to-PRBC ratio of more than 1:1.5 was associated with increased 30-day survival among patients with severe bleeding after trauma. This result supports the use of early, high FFP-to-PRBC transfusion ratios in patients with severe trauma.
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Affiliation(s)
- Florian Roquet
- Service d’Anesthésie-réanimation, Hôpital Européen Georges-Pompidou, Assistance Publique–Hôpitaux de Paris, Paris, France
- Service de Biostatistique et Informatique Médicale, Unité INSERM UMR 1153, Université Paris Diderot, Paris, France
| | - Arthur Neuschwander
- Service d’Anesthésie-réanimation, Hôpital Européen Georges-Pompidou, Assistance Publique–Hôpitaux de Paris, Paris, France
| | - Sophie Hamada
- Service d’Anesthésie-réanimation, Centre Hospitalier Universitaire Bicêtre, Université Paris Sud, Assistance Publique–Hôpitaux de Paris, Le Kremlin Bicêtre, France
| | - Gersende Favé
- Service d’Anesthésie-réanimation, Hôpital Européen Georges-Pompidou, Assistance Publique–Hôpitaux de Paris, Paris, France
| | - Arnaud Follin
- Service d’Anesthésie-réanimation, Hôpital Européen Georges-Pompidou, Assistance Publique–Hôpitaux de Paris, Paris, France
| | - David Marrache
- Service d’Anesthésie-réanimation, Hôpital Européen Georges-Pompidou, Assistance Publique–Hôpitaux de Paris, Paris, France
| | - Bernard Cholley
- Service d’Anesthésie-réanimation, Hôpital Européen Georges-Pompidou, Assistance Publique–Hôpitaux de Paris, Paris, France
| | - Romain Pirracchio
- Service d’Anesthésie-réanimation, Hôpital Européen Georges-Pompidou, Assistance Publique–Hôpitaux de Paris, Paris, France
- Service de Biostatistique et Informatique Médicale, Unité INSERM UMR 1153, Université Paris Diderot, Paris, France
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4
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Association of Blood Component Ratio With Clinical Outcomes in Patients After Trauma and Massive Transfusion: A Systematic Review. Adv Emerg Nurs J 2017; 38:157-68. [PMID: 27139137 DOI: 10.1097/tme.0000000000000103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Component ratios that mimic whole blood may produce survival benefit in patients massively transfused after trauma; other outcomes have not been reviewed. The purpose of this review was to systematically analyze studies where clinical outcomes were compared on the basis of the component ratios administered during massive transfusion in adult patients after trauma. PubMed, CINAHL, and MEDLINE (Ovid) were searched for studies published in English between 2007 and 2015, performed at Level I or major trauma centers. Twenty-one studies were included in the analysis. We used an adapted 9-item instrument to assess bias risk. The average bias score for the studies was 2.86 ± 1.39 out of 16, indicating a low bias risk. The most common bias sources were lack of data about primary outcomes and adverse events. Those who received high ratios experienced not only greater survival benefit but also higher rates of multiple-organ failure; all other clinical outcomes findings were equivocal.
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5
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Matsumoto H, Hara Y, Yagi T, Saito N, Mashiko K, Iida H, Motomura T, Nakayama F, Okada K, Yasumatsu H, Sakamoto T, Seo T, Konda Y, Hattori Y, Yokota H. Impact of urgent resuscitative surgery for life-threatening torso trauma. Surg Today 2016; 47:827-835. [PMID: 27888344 PMCID: PMC5486610 DOI: 10.1007/s00595-016-1451-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 10/28/2016] [Indexed: 11/28/2022]
Abstract
Purpose This study investigated the advantages of performing urgent resuscitative surgery (URS) in the emergency department (ED); namely, our URS policy, to avoid a delay in hemorrhage control for patients with severe torso trauma and unstable vital signs. Methods We divided 264 eligible cases into a URS group (n = 97) and a non-URS group (n = 167) to compare, retrospectively, the observed survival rate with the predicted survival using the Trauma and Injury Severity Score (TRISS). Results While the revised trauma score and the injury severity score were significantly lower in the URS group than in the non-URS group, the observed survival rate was significantly higher than the predicted rate in the URS (48.5 vs. 40.2%; p = 0.038). URS group patients with a systolic blood pressure (SBP) <90 mmHg and a Glasgow coma scale (GCS) score of ≥9 had significantly higher observed survival rates than predicted survival rates (0.433 vs. 0.309, p = 0.008), (0.795 vs. 0.681, p = 0.004). The implementation of damage control surgery (DCS) was found to be a significant predictor of survival (OR 5.23, 95% CI 0.113–0.526, p < 0.010). Conclusion The best indications for the URS policy are an SBP <90 mmHg, a GCS ≥9 on ED arrival, and/or the need for DCS. By implementing our URS policy, satisfactory survival of patients requiring immediate hemostatic surgery was achieved.
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Affiliation(s)
- Hisashi Matsumoto
- Shock and Trauma Centre, Nippon Medical School Chiba Hokusoh Hospital, 1715, Kamakari, Inzai, Chiba Prefecture, 270-1694, Japan. .,Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan.
| | - Yoshiaki Hara
- Shock and Trauma Centre, Nippon Medical School Chiba Hokusoh Hospital, 1715, Kamakari, Inzai, Chiba Prefecture, 270-1694, Japan.,Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Takanori Yagi
- Shock and Trauma Centre, Nippon Medical School Chiba Hokusoh Hospital, 1715, Kamakari, Inzai, Chiba Prefecture, 270-1694, Japan.,Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Nobuyuki Saito
- Shock and Trauma Centre, Nippon Medical School Chiba Hokusoh Hospital, 1715, Kamakari, Inzai, Chiba Prefecture, 270-1694, Japan.,Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Kazuki Mashiko
- Shock and Trauma Centre, Nippon Medical School Chiba Hokusoh Hospital, 1715, Kamakari, Inzai, Chiba Prefecture, 270-1694, Japan.,Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Hiroaki Iida
- Shock and Trauma Centre, Nippon Medical School Chiba Hokusoh Hospital, 1715, Kamakari, Inzai, Chiba Prefecture, 270-1694, Japan.,Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Tomokazu Motomura
- Shock and Trauma Centre, Nippon Medical School Chiba Hokusoh Hospital, 1715, Kamakari, Inzai, Chiba Prefecture, 270-1694, Japan.,Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Fumihiko Nakayama
- Shock and Trauma Centre, Nippon Medical School Chiba Hokusoh Hospital, 1715, Kamakari, Inzai, Chiba Prefecture, 270-1694, Japan.,Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Kazuhiro Okada
- Shock and Trauma Centre, Nippon Medical School Chiba Hokusoh Hospital, 1715, Kamakari, Inzai, Chiba Prefecture, 270-1694, Japan.,Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Hiroshi Yasumatsu
- Shock and Trauma Centre, Nippon Medical School Chiba Hokusoh Hospital, 1715, Kamakari, Inzai, Chiba Prefecture, 270-1694, Japan.,Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Taigo Sakamoto
- Shock and Trauma Centre, Nippon Medical School Chiba Hokusoh Hospital, 1715, Kamakari, Inzai, Chiba Prefecture, 270-1694, Japan.,Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Takao Seo
- Shock and Trauma Centre, Nippon Medical School Chiba Hokusoh Hospital, 1715, Kamakari, Inzai, Chiba Prefecture, 270-1694, Japan.,Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Yusuke Konda
- Shock and Trauma Centre, Nippon Medical School Chiba Hokusoh Hospital, 1715, Kamakari, Inzai, Chiba Prefecture, 270-1694, Japan.,Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - You Hattori
- Shock and Trauma Centre, Nippon Medical School Chiba Hokusoh Hospital, 1715, Kamakari, Inzai, Chiba Prefecture, 270-1694, Japan.,Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Hiroyuki Yokota
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
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Umemura T, Nakamura Y, Nishida T, Hoshino K, Ishikura H. Fibrinogen and base excess levels as predictive markers of the need for massive blood transfusion after blunt trauma. Surg Today 2015; 46:774-9. [PMID: 26530517 PMCID: PMC4887527 DOI: 10.1007/s00595-015-1263-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 07/15/2015] [Indexed: 12/01/2022]
Abstract
Background Assessment blood consumption and trauma-associated severe hemorrhage scores are useful for predicting the need for massive transfusion (MT) in severe trauma patients. However, fibrinogen (Fbg) and base excess (BE) levels might also be useful indicators for the need for MT. We evaluated the accuracy of prediction for MT of the scoring system vs. Fbg and BE. Methods The subjects of this retrospective single center observational study were patients with injury severity score ≥16 trauma, divided into a non-MT group and an MT group. We compared variables, including the scoring system (comprising vital signs and focused assessment with sonography for trauma; FAST) and Fbg between the groups. We then performed a multiple logistic regression modeling and a receiver operating characteristic analysis to clarify which value was the most useful predictive indicator for MT. Results There were 114 patients in the non-MT group and 39 in the MT group. The level of Fbg and BE were independent predictors of MT. The area under the curve values for Fbg and BE were 0.765 and 0.845, respectively, and the optimal cutoff values of Fbg and BE were 211 mg/dL and −1.4, respectively. Conclusions Fbg and BE levels can be used as an independent predictor for MT.
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Affiliation(s)
- Takehiro Umemura
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonanku, Fukuoka, 814-0180, Japan
| | - Yoshihiko Nakamura
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonanku, Fukuoka, 814-0180, Japan
| | - Takeshi Nishida
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonanku, Fukuoka, 814-0180, Japan
| | - Kota Hoshino
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonanku, Fukuoka, 814-0180, Japan
| | - Hiroyasu Ishikura
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonanku, Fukuoka, 814-0180, Japan.
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7
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Peralta R, Vijay A, El-Menyar A, Consunji R, Abdelrahman H, Parchani A, Afifi I, Zarour A, Al-Thani H, Latifi R. Trauma resuscitation requiring massive transfusion: a descriptive analysis of the role of ratio and time. World J Emerg Surg 2015; 10:36. [PMID: 26279672 PMCID: PMC4536606 DOI: 10.1186/s13017-015-0028-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 07/23/2015] [Indexed: 11/10/2022] Open
Abstract
Objective We aimed to evaluate whether early administration of high plasma to red blood cells ratios influences outcomes in injured patients who received massive transfusion protocol (MTP). Methods A retrospective analysis was conducted at the only level 1 national trauma center in Qatar for all adult patients(≥18 years old) who received MTP (≥10 units) of packed red blood cell (PRBC) during the initial 24 h post traumatic injury. Data were analyzed with respect to FFB:PRBC ratio [(high ≥ 1:1.5) (HMTP) vs. (low < 1:1.5) (LMTP)] given at the first 4 h post-injury and also between (>4 and 24 h). Mortality, multiorgan failure (MOF) and infectious complications were studied as well. Results During the study period, a total of 4864 trauma patients were admitted to the hospital, 1.6 % (n = 77) of them met the inclusion criteria. Both groups were comparable with respect to initial pH, international normalized ratio, injury severity score, revised trauma score and development of infectious complications. However, HMTP was associated with lower crude mortality (41.9 vs. 78.3 %, p = 0.001) and lower rate of MOF (48.4 vs. 87.0 %, p = 0.001). The number of deaths was 3 times higher in LMTP in comparison to HMTP within the first 30 days (36 vs. 13 cases). The majority of deaths occurred within the first 24 h (80.5 % in LMTP and 69 % in HMTP) and particularly within the first 6 h (55 vs. 46 %). Conclusions Aggressive attainment of high FFP/PRBC ratios as early as 4 h post-injury can substantially improve outcomes in trauma patients.
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Affiliation(s)
- Ruben Peralta
- Trauma Surgery Section, Hamad Trauma Center, Hamad General Hospital, Doha, Qatar
| | - Adarsh Vijay
- Trauma Surgery Section, Hamad Trauma Center, Hamad General Hospital, Doha, Qatar
| | - Ayman El-Menyar
- Clinical Research, Trauma Surgery Section, Hamad General Hospital, HMC, PO Box 3050, Doha, Qatar ; Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
| | - Rafael Consunji
- Trauma Surgery Section, Hamad Trauma Center, Hamad General Hospital, Doha, Qatar
| | - Husham Abdelrahman
- Trauma Surgery Section, Hamad Trauma Center, Hamad General Hospital, Doha, Qatar
| | - Ashok Parchani
- Trauma Surgery Section, Hamad Trauma Center, Hamad General Hospital, Doha, Qatar
| | - Ibrahim Afifi
- Trauma Surgery Section, Hamad Trauma Center, Hamad General Hospital, Doha, Qatar
| | - Ahmad Zarour
- Trauma Surgery Section, Hamad Trauma Center, Hamad General Hospital, Doha, Qatar ; Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
| | - Hassan Al-Thani
- Trauma Surgery Section, Hamad Trauma Center, Hamad General Hospital, Doha, Qatar
| | - Rifat Latifi
- Trauma Surgery Section, Hamad Trauma Center, Hamad General Hospital, Doha, Qatar ; Department of Surgery, University of Arizona, Tucson, AZ USA
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8
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Ponschab M, Schöchl H, Gabriel C, Süssner S, Cadamuro J, Haschke-Becher E, Gratz J, Zipperle J, Redl H, Schlimp CJ. Haemostatic profile of reconstituted blood in a proposed 1:1:1 ratio of packed red blood cells, platelet concentrate and four different plasma preparations. Anaesthesia 2015; 70:528-36. [DOI: 10.1111/anae.13067] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2015] [Indexed: 12/31/2022]
Affiliation(s)
- M. Ponschab
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology; AUVA Research Centre; Vienna Austria
| | - H. Schöchl
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology; AUVA Research Centre; Vienna Austria
- Department of Anaesthesiology and Intensive Care; AUVA Trauma Centre; Salzburg Austria
| | - C. Gabriel
- Red Cross Blood Transfusion Service for Upper Austria; Linz Austria
| | - S. Süssner
- Red Cross Blood Transfusion Service for Upper Austria; Linz Austria
| | - J. Cadamuro
- Department of Laboratory Medicine; Paracelsus Medical University Salzburg; Salzburg Austria
| | - E. Haschke-Becher
- Department of Laboratory Medicine; Paracelsus Medical University Salzburg; Salzburg Austria
| | - J. Gratz
- Department of Anaesthesia; General Intensive Care and Pain Control; Medical University of Vienna; Vienna Austria
| | - J. Zipperle
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology; AUVA Research Centre; Vienna Austria
| | - H. Redl
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology; AUVA Research Centre; Vienna Austria
| | - C. J. Schlimp
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology; AUVA Research Centre; Vienna Austria
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9
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Tosounidis TI, Giannoudis PV. Pelvic fractures presenting with haemodynamic instability: treatment options and outcomes. Surgeon 2013; 11:344-51. [PMID: 23932669 DOI: 10.1016/j.surge.2013.07.004] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2013] [Revised: 07/08/2013] [Accepted: 07/17/2013] [Indexed: 12/29/2022]
Abstract
The management of trauma patients with haemodynamic instability and an unstable pelvic fracture is an issue of vivid debate in "trauma community". A multidisciplinary approach needs to be instituted regarding the required diagnostic and therapeutic measures. Control of haemorrhage is the first priority. Arterial embolization and/or preperitoneal pelvic packing follow the provisional skeletal pelvic stabilization. The sequence of these interventions still remains an issue of controversy. It needs to be determined on an institutional basis based on the available local resources such as angiography suite and whole-body CT scan and the expertise of the treating surgical team. Despite the fact that recent advances in diagnostic modalities and trauma care systems have improved the overall outcome of patients with pelvic fractures, the early mortality associated with high-energy pelvic injuries presenting with haemodynamic instability remains high. Any suspected injured person with pelvic ring injury should automatically be taken to a level one-trauma centre where all the facilities required are in place for these patients to survive.
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Affiliation(s)
- Theodoros I Tosounidis
- Leeds Biomedical Research Unit, Academic Department of Trauma & Orthopaedic Surgery, Clarendon Wing, Floor A, Great George Street, Leeds General Infirmary, LS1 3EX Leeds, UK
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