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Improving outcome of trauma patients by implementing patient blood management

Füllenbach, Christoph; Zacharowski, Kai; Meybohm, Patrick

Current Opinion in Anesthesiology: April 2017 - Volume 30 - Issue 2 - p 243–249
doi: 10.1097/ACO.0000000000000427
TRAUMA AND TRANSFUSION: Edited by Kai Zacharowski

Purpose of review Patient blood management aims to improve patient outcome and safety by reducing the number of unnecessary red blood cell transfusions and vitalizing patient-specific anemia reserves. While this is increasingly recognized as best clinical practice in elective surgery, the implementation in the setting of trauma is restrained because of typically nonelective (emergency) surgery and, in specific circumstances, allogeneic blood transfusions as life-saving therapy.

Recent findings Viscoelastic diagnostics allow a precise identification of trauma-induced coagulopathy. A coagulation factor concentrate-based therapy is increasingly recognized as a fast and effective concept to correct coagulopathy and minimize blood loss. Using smaller tubes has a great potential to reduce the severity of phlebotomy-induced anemia. Washed cell salvage may reduce the number of allogeneic blood transfusions. Intravenous iron (with or without erythropoietin) may result in an increase of hemoglobin levels and reduced red blood cell transfusion requirements. Although a restrictive transfusion strategy is recommended in general, a target hemoglobin level of 7–9 g/dl is recommended in acute bleeding patients.

Summary In the setting of trauma, options to avoid unnecessary blood loss and reduce blood transfusion are manifold. These are likely to improve safety and outcome of trauma patients while potentially reducing therapeutic costs.

Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt am Main, Germany

Correspondence to Prof. Dr Patrick Meybohm, Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt am Main 60590, Germany. Tel: +49 69 6301 87461; e-mail: patrick.meybohm@kgu.de

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