Trauma and hemorrhage

Question 1

Damage Control Resuscitation

Answer 1

• Holcomb et al. (2015): Demonstrated that early and aggressive blood product use was associated with improved survival in trauma patients with severe hemorrhage.

Question 2

Tranexamic Acid (TXA) in Trauma

Answer 2

• CRASH-2 (2010): Early administration of tranexamic acid within 3 hours of injury reduced death due to bleeding and all-cause mortality in trauma patients.
• MATTERs (2012): Use of TXA with a high ratio PRBC: FFP was associated with improved survival in combat-related traumatic injuries.

Question 3

Massive transfusion ratio

Answer 3

• PROPPR (2015): In patients with severe trauma and major bleeding, early administration of plasma, platelets, and red blood cells in a 1:1:1 ratio did not result in significantly lower 30-day mortality than a 1:1:2 ratio but did result in significantly increased hemostasis and fewer deaths due to exsanguination by 24 hours.

Question 4

Permissive Hypotension

Answer 4

• Cotterill et al. (2011): Reviewed available evidence and concluded that a strategy of permissive hypotension (delayed aggressive fluid resuscitation until bleeding is controlled) may improve outcomes, particularly in penetrating torso trauma.
• SOAP II (2010): Showed no significant difference in the primary outcome (28-day mortality) between lower vs higher mean arterial pressure targets in shock but more patients in the lower target group had acute kidney injury.