The last few years have given way to a paradigm shift in the resuscitation of traumatic hemorrhage. Using observational data from military settings, resuscitation strategies utilizing reactive correction of coagulopathy have given way to strategies mimicking whole blood transfusion. Limited evidence suggests PRBC:FFP:Platelet ratios nearing 1:1:1 may be beneficial in resuscitation from traumatic hemorrhage.
This observational study of trauma patients followed lactate levels and measures of coagulopathy during the acute resuscitative phase from major trauma. 106 patients with median Injury Severity Score of 34 received a median of 8 units of PRBCs, 6 units of FFP, and a smattering of platelets and cryoprecipitate transfusions. Lactate levels, as compared by median and IQR, did not significantly normalize following the initial transfusion, requiring a full day of therapeutic intervention to improve. Likewise, measures of coagulopathy did not reflect improvement in the acute phase, tending to normalize only after a full day. It did not matter whether patients received a small, moderate, or large amount of resuscitation.
This study only comments on surrogate outcomes – serum lactate, markers of coagulopathy – and not patient-oriented outcomes, but it serves as a reminder the science is clearly not settled regarding the optimal, cost-effective fashion to resuscitate patients from traumatic hemorrhage. While many centers have fully adopted whole blood-style resuscitation strategies, it would be incorrect to conclude we have any sort of certainty in the matter.
“Hemostatic resuscitation is neither hemostatic nor resuscitative in trauma hemorrhage”
http://www.ncbi.nlm.nih.gov/pubmed/24553520