Hemorrhage is the leading cause of death in the first hour after arrival at a trauma center, causes 80% of OR deaths and 50% of deaths in the first 24 hours (1). A significant number of patients arrive coagulopathic and mortality is nearly 50% in those patients (versus 10% of those with normal coagulation on admission) (2). Massive transfusion protocols (predefined fixed ration resuscitation) significantly decreases mortality AND blood product use (ie, ‘go big early’) (3). MTP’s also reduce organ failure, sepsis, pneumonia, open abdomens and compartment syndrome (apparently due to less blood product exposure) (4). Plasma:platelet:RBC ratios of 1:1:1 reduces exsanguination compared to 1:1:2. (5). Reaching these targets within 6 hours reduces mortality compared to reaching the targets after 6 hours (6). Every minute of delay in receiving the MTP cooler increases mortality (7). Early plasma, given in the field, reduces mortality (8). PCC are associated with improved outcome in trauma hemorrhage (9). Whole blood resuscitation is advocated by the U.S military, has gained significant interest in civilian trauma centers and is undergoing further evaluation (10).
1. Sauaia et al. J Trauma 2006.
2. Brohi et al. J Trauma 2003.
3. Cotton et al. J Trauma 2008;64:1177-1183
4. Cotton et al. J Trauma 2009;66:41-49.
5. Holcomb et al. JAMA 2015;313:471-82. (PROPPR)
6. Holcomb et al. JAMA Surg 2013;148:127-36. (PROMMTT)
7. Meyer et al. JTACS 2017;83:19-24.
8. Sperry et al. NEJM 2018;379:315-26. (PAMPer)
9. Zeeshan et al. JTACS 2019;87:274-81.
10. Jones TB et al. J Spec Oper Med 2019 Winter;19(4):88-90.
5. Holcomb et al. JAMA 2015;313:471-82. (PROPPR)
6. Holcomb et al. JAMA Surg 2013;148:127-36. (PROMMTT)
7. Meyer et al. JTACS 2017;83:19-24.
8. Sperry et al. NEJM 2018;379:315-26. (PAMPer)
9. Zeeshan et al. JTACS 2019;87:274-81.
10. Jones TB et al. J Spec Oper Med 2019 Winter;19(4):88-90.
