| Goal-directed hemostatic resuscitation for massively bleeding patients: the Copenhagen concept. | |
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MedLine Citation:
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PMID: 20951650 Owner: NLM Status: In-Process |
Abstract/OtherAbstract:
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BACKGROUND: Continued hemorrhage remains a major cause of mortality in massively transfused patients, many of whom develop coagulopathy. A review of transfusion practice for these patients at our hospital revealed that a significant proportion received suboptimal transfusion therapy. Survivors had higher platelets count than non-survivors. METHODS: For massively transfused patients with hemodynamic instability, we introduced the concept of transfusion packages comprising five units of red blood cells, five units of fresh frozen plasma and two units of platelet concentrates. Thrombelastogram analysis was validated for routine laboratory use and implemented in the blood bank for monitoring coagulopathy and guiding transfusion therapy. Anaesthetists at our hospital were trained in functional haemostasis management based on analysis of thrombelastograms. RESULTS: Intraoperative administration of transfusion packages for patients operated on for a ruptured abdominal aortic aneurysm was associated with a reduction in mortality from 56% to 34% (p = 0.02). When comparing massively transfused patients treated with hemostatic control resuscitation, i.e., transfusion package therapy during hemodynamic instability and thromboelastogram--monitored and guided transfusion therapy, with controls treated in accordance with existing transfusion guidelines, mortality was reduced from 31% to 20% (p = 0.002). CONCLUSION: The initiative from the blood bank, i.e., transfusion packages for patients with uncontrollable bleeding and based on the thromboelastogram when hemodynamic control is established, has improved the transfusion practice and survival in massively transfused patients at our hospital. |
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Authors:
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Pär I Johansson |
Publication Detail:
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Type: Journal Article Date: 2010-10-15 |
Journal Detail:
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Title: Transfusion and apheresis science : official journal of the World Apheresis Association : official journal of the European Society for Haemapheresis Volume: 43 ISSN: 1473-0502 ISO Abbreviation: Transfus. Apher. Sci. Publication Date: 2010 Dec |
Date Detail:
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Created Date: 2010-11-29 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101095653 Medline TA: Transfus Apher Sci Country: England |
Other Details:
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Languages: eng Pagination: 401-5 Citation Subset: T |
Copyright Information:
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Copyright © 2010 Elsevier Ltd. All rights reserved. |
Affiliation:
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Section for Transfusion Medicine, Capital Region Blood Bank, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. per.johansson@rh.regionh.dk |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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