Treatment Alternatives in Massive Hemorrhage
Mohammed Habib Abd El-Mgeed;
Abstract
Massive hemorrhage can be arbitrarily considered as a situation where 1-1.5 blood volumes may need to be infused either acutely or within a 24hour period.
It is imperative to recognise major blood loss early andinstitute effective action promptly if shock and its consequencesare to be prevented.
Hemorrhage in trauma is the combined result of blood loss and consumption coagulopathy, with potentiating effects of acidosis, hypothermia, and electrolyte disturbance. Moreover, severe tissue injury and hypoperfusion have been identified as important drivers of an endogenous trauma-related coagulopathy that is associated with poor outcome.
Damagecontrol resuscitation (DCR) is a new paradigm for patients withmassive bleeding. It consists of permissive hypotension,hemostatic resuscitation and transfusion strategies and damage control surgery.
Hypotensive resuscitation has been described as a method to improve patient outcomes by simultaneouslylimiting active hemorrhage and dilutional coagulopathy by tolerating lower than normal blood pressures.
Hemostatic resuscitation and transfusion strategies aim to minimize coagulopathy, they have been moved towardminimizing crystalloid infusion for resuscitation andusing a high ratio of blood products.
Massive transfusionis historically defined as transfusion of 10 units of red cells in 24 hours in a response to massive and uncontrolled hemorrhage. With more rapid and effective therapy, definitions such as five units over three hours are more effective in identifying patients needing rapid issue of blood products for serious injuries because of uncontrolled hemorrhage.
The concept of MTP is recentand such protocols areadvised in patients with massive bleeding who present thelethal triad of acidosis, hypothermia and coagulopathy
Theaim is to treat the patient early and aggressively with blood products in order to avoid exsanguination and coagulopathy.
Damage control surgery is an initial controlof hemorrhage and contamination followed byintraperitoneal packing and rapid closure as wellas resuscitation in the intensive care unit beforetransferring patients to the operating room for adefinitive laparotomy.The indicationsfor damage control surgery are mainly physiologicalchanges such as presence of hypothermia, acidosis and coagulopathy.
Due to the disadvantages of blood transfusion and already low supplies of fresh blood, safe, available and effective alternatives substitute banked blood. Alternatives to correct coagulopathy such as fibrinogen, prothrombin complex and recombinant F VII and or attractive alternatives to allogenic red blood cells as perfluorocarbon emulsions (PFCs) have been recently considered.
It is imperative to recognise major blood loss early andinstitute effective action promptly if shock and its consequencesare to be prevented.
Hemorrhage in trauma is the combined result of blood loss and consumption coagulopathy, with potentiating effects of acidosis, hypothermia, and electrolyte disturbance. Moreover, severe tissue injury and hypoperfusion have been identified as important drivers of an endogenous trauma-related coagulopathy that is associated with poor outcome.
Damagecontrol resuscitation (DCR) is a new paradigm for patients withmassive bleeding. It consists of permissive hypotension,hemostatic resuscitation and transfusion strategies and damage control surgery.
Hypotensive resuscitation has been described as a method to improve patient outcomes by simultaneouslylimiting active hemorrhage and dilutional coagulopathy by tolerating lower than normal blood pressures.
Hemostatic resuscitation and transfusion strategies aim to minimize coagulopathy, they have been moved towardminimizing crystalloid infusion for resuscitation andusing a high ratio of blood products.
Massive transfusionis historically defined as transfusion of 10 units of red cells in 24 hours in a response to massive and uncontrolled hemorrhage. With more rapid and effective therapy, definitions such as five units over three hours are more effective in identifying patients needing rapid issue of blood products for serious injuries because of uncontrolled hemorrhage.
The concept of MTP is recentand such protocols areadvised in patients with massive bleeding who present thelethal triad of acidosis, hypothermia and coagulopathy
Theaim is to treat the patient early and aggressively with blood products in order to avoid exsanguination and coagulopathy.
Damage control surgery is an initial controlof hemorrhage and contamination followed byintraperitoneal packing and rapid closure as wellas resuscitation in the intensive care unit beforetransferring patients to the operating room for adefinitive laparotomy.The indicationsfor damage control surgery are mainly physiologicalchanges such as presence of hypothermia, acidosis and coagulopathy.
Due to the disadvantages of blood transfusion and already low supplies of fresh blood, safe, available and effective alternatives substitute banked blood. Alternatives to correct coagulopathy such as fibrinogen, prothrombin complex and recombinant F VII and or attractive alternatives to allogenic red blood cells as perfluorocarbon emulsions (PFCs) have been recently considered.
Other data
| Title | Treatment Alternatives in Massive Hemorrhage | Other Titles | الطرق الغير تقليدية الحديثة لعلاج حالات النزف الشديد | Authors | Mohammed Habib Abd El-Mgeed | Issue Date | 2015 |
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