Traume, blødning og optimal transfusjonsstrategi

Abstract

ABSTRACT The correct use of blood products in massively bleeding patients remains a controversial topic even today. Hemorrhage is the leading cause of death in the trauma population (40%). Trauma induced coagulopathy together with acidosis, hypothermia and hemodilution is considered to play a major role in the unbalance of hemostasis that occurs in these patients. The use of Fresh Frozen Plasma (FFP) in equal ratios to erythrocytes has developed into standard of care in many trauma centers. The benefit of this treatment, which aims to imitate whole blood, was first noticed during the Iraq war. Several retrospective studies were conducted in civilian trauma centers with results supporting increased survival in the groups receiving higher ratios of FFP:erythrocytes, but recent studies have pointed out the issue of survival bias. One has to remember that prethawed FFP is a limited resource. The surviving patients seem to be the strongest ones, and thereby having the time to receive increased amounts of FFP. 25% of the trauma population is estimated to have a coagulopathy based on Prothrombin time. The standard laboratory tests APTT, PTT and platelet count analyzes separated bits of the coagulation system. Thromboelastography (TEG) has been proposed as a better tool. Despite of the many benefits that this instrument holds, there is a lack of evidence for its use. Studies have shown mixed results in regards to correlation with the standard tests. The present study addresses the issues of transfusion guidelines, TEG, and the use of resuscitation fluid (hypertonic saline vs isotone saline vs colloids).