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Trauma-associated bleeding: management of massive transfusion

Stephens, Christopher T.; Gumbert, Sam; Holcomb, John B.

Current Opinion in Anaesthesiology: April 2016 - Volume 29 - Issue 2 - p 250–255
doi: 10.1097/ACO.0000000000000306
TRAUMA AND TRANSFUSION: Edited by Kai Zacharowski

Purpose of review Early treatment goals in the bleeding trauma patient have changed based on recent research findings. Trauma patients requiring a massive transfusion protocol have shown a decreased mortality based on a more aggressive and balanced approach to blood product resuscitation. This chapter will review the recent advances in managing the bleeding trauma patient.

Recent findings Recent data have suggested a combined approach of early ratio-based blood product use, bedside viscoelastic hemostatic assays, hemostatic resuscitation, and finally goal-directed therapy to complete resuscitation.

Summary There is now evidence to support the early use of a 1 : 1 : 1 blood product transfusion protocol to restore lost circulating volume, improve oxygen carrying capacity, replace diluted platelets, and replenish clotting factors in massively bleeding trauma patients. Further study is needed to determine whether prehospital initiation of blood products and pharmacological adjuncts will improve outcomes.

aDepartment of Anesthesiology, Division of Trauma Anesthesiology

bCenter for Translational Injury Research

cDepartment of Surgery, Division of Acute Care Surgery, The University of Texas Health Science Center at Houston, Houston, Texas, USA

Correspondence to Christopher T. Stephens, MD, Department of Anesthesiology, University of Texas Health Science Center at Houston, 6431 Fannin, MSMB 5.020, Houston, TX 77030, USA. Tel: +1 713 500 6222; fax: +1 713 500 6208; e-mail:

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