Massive Transfusion in Trauma

Authors: Lier, Heiko; Hossfeld, Björn

Affiliations: Department of Anesthesiology and Intensive Care Medicine, University of Cologne, Faculty of Medicine, and University Hospital Cologne. Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Center of Emergency Medicine, HEMS ‘Christoph 22’, Armed Forces Hospital, Ulm, Germany.

Publication: Current opinion in anaesthesiology. 2024. 37. 117–124

ABSTRACT: PURPOSE OF REVIEW: The purpose of this review is to provide an overview of currently recommended treatment approaches for traumatic hemorrhage shock, with a special focus on massive transfusion. RECENT FINDINGS: Severe trauma patients require massive transfusion, but consensual international definitions for traumatic hemorrhage shock and massive transfusion are missing. Current literature defines a massive transfusion as transfusion of a minimum of 3-4 packed red blood cells within 1 h. Using standard laboratory and/or viscoelastic tests, earliest diagnosis and treatment should focus on trauma-induced coagulopathy and substitution of substantiated deficiencies. SUMMARY: To initiate therapy immediately massive transfusion protocols are helpful focusing on early hemorrhage control using hemostatic dressing and tourniquets, correction of metabolic derangements to decrease coagulopathy and substitution according to viscoelastic assays and blood gases analysis with tranexamic acid, fibrinogen concentrate, red blood cells, plasma and platelets are recommended. Alternatively, the use of whole blood is possible. If needed, further support using prothrombin complex, factor XIII or desmopressin is suggested.