Massive transfusion in trauma patients

Abstract

About 5–15% of severely injured patients require massive blood transfusion (MBT) defined by the need of equal or more than 10 units of packed red blood cells (PRBCs) within the first post‐traumatic 24 h. Continued haemorrhage is still a leading cause of death in trauma patients. Treatment principles of haemorrhage subsume the surgical control of bleeding and fluid resuscitation. The latter includes not only crystalloid and colloid infusion but also blood component therapy comprising PRBC, fresh frozen plasma, platelets and fibrinogen. In addition, prevention and therapy of hypothermia and acidosis is also an important treatment target. However, there is a lack of definite and evaluated transfusion protocols. According to expert opinion, the relation of PRBC to fresh frozen plasma is recommended to count 1 : 1. One of the topmost complications of haemorrhage in trauma patients comprises the underestimation of coagulopathy and delayed therapy. Being a well‐known fact, coagulopathy significantly increases the probability of mortality. The early recognition of coagulopathy is definitely improved by the use of bedside thrombelastography and thereby provides a basis for its treatment optimization. In general, prognosis of trauma patients receiving MBT has been quite serious in the past. Nevertheless, there is a notable increase of MBT receiving trauma patients’ outcome since the early 1990s. Although MBT is considered as to be an independent mortality risk factor, at least every second trauma patient with MBT survives. No cut‐off value for the number of PRBC could yet be determined in the literature. Thereby, rationale and extended transfusion management even comprising high amounts of blood components is justified.