Massive transfusion for trauma: opportunities and risks

Abstract

Massive transfusion is a response to uncontrolled haemorrhage, and uncontrolled haemorrhage is the leading cause of preventable death following injury. To be successful, massive transfusion must be timely and directed at the needs of the patient for volume replacement, oxygen transport, and the prevention or correction of coagulopathy. This means that the full array of blood components must be available quickly, that the components need to be of high quality, and that the components need to be given in appropriate ratios and sequences and guided by the condition and response of the patient. One in four severely injured patients present to emergency care with a coagulopathy that is related to the type and severity of injury. The mortality of coagulopathic patients is four times higher than other patients with equivalent injury severity scores. Giving more plasma and perhaps platelets earlier in massive transfusion appears to be associated with substantially improved outcome in this 2% of civilian and 8% of military casualties where resource use and mortality are concentrated. However, AB plasma is in short supply, the use of more plasma containing products is associated with an increased incidence of complications, and there is a need for more concentrated plasma products. There are opportunities and risks associated with changing the way we transfuse the injured and with developing new blood products to better meet their needs.