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Haemostatic resuscitation in trauma: the next generation

Stensballe, Jakob; Ostrowski, Sisse R.; Johansson, Pär I.

Current Opinion in Critical Care: December 2016 - Volume 22 - Issue 6 - p 591–597
doi: 10.1097/MCC.0000000000000359
TRAUMA-ASSOCIATED COAGULOPATHY: Edited by Kjetil Sunde and Christina Gaarder
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Purpose of review To discuss the recent developments in and evolvement of next generation haemostatic resuscitation in bleeding trauma.

Recent findings Mortality from major trauma is a worldwide problem, and massive haemorrhage remains a major cause of potentially preventable deaths. Development of coagulopathy further increases trauma mortality emphasizing that coagulopathy is a key target in the phase of bleeding. The pathophysiology of coagulopathy in trauma reflects at least three distinct mechanisms that may be present isolated or coexist: acute traumatic coagulopathy, coagulopathy associated with the lethal triad, and consumptive coagulopathy. The concepts of ‘damage control surgery’ and ‘damage control resuscitation’ have been developed to ensure early control of bleeding and coagulopathy to improve outcome in bleeding trauma. Haemostatic resuscitation aims at controlling coagulopathy and consists of a ratio driven strategy aiming at 1 : 1 : 1, using tranexamic acid according to CRASH-2, and applying haemostatic monitoring enabling a switch to a goal-directed approach when bleeding slows. Haemostatic resuscitation is the mainstay of trauma resuscitation and is associated with improved survival.

Summary The next generation of haemostatic resuscitation aims at applying a ratio 1 : 1 : 1 driven strategy while using antifibrinolytics, haemostatic monitoring and avoiding critical fibrinogen deficiency by substitution.

aSection for Transfusion Medicine, Capital Region Blood Bank, Copenhagen University Hospital, Rigshospitalet, Denmark

bDepartment of Anaesthesia, Centre of Head and Orthopedics, Copenhagen University Hospital, Rigshospitalet, Denmark

cDepartment of Surgery, Division of Acute Care Surgery, Centre for Translational Injury Research (CeTIR), University of Texas Medical School at Houston, Texas, USA

dCentre for Systems Biology, The School of Engineering and Natural Sciences, University of Iceland, Iceland

Correspondence to Jakob Stensballe, MD, PhD, Consultant Anaesthetist, Section for Transfusion Medicine, Capital Region Blood Bank & Department of Anaesthesia, Centre of Head and Orthopedics, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark. Tel: +45 2753 8687; fax: +45 35390038; e-mail: jakob.stensballe@regionh.dk

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