Effect of Plasma and Red Blood Cell Transfusions on Survival in Patients with Combat Related Traumatic Injuries.

摘要

Hemorrhage from traumatic injuries is the second most common cause of death and the most common cause of potentially preventable deaths from combat related injuries. Upon autopsy review, it was estimated that 15% to 20% of deaths that occur in combat were preventable with appropriate treatment, with 66% to 80% of these deaths occurring from hemorrhagic shock. Death from severe traumatic injuries occurs quickly, usually within 6 hours to 12 hours from hospital admission. Strategies or therapeutic principles that can be rapidly applied have the potential to prevent death from hemorrhagic shock and have a significant impact on improving survival for patients with traumatic injuries. According to Advanced Trauma Life Support guidelines, the standard approach to the resuscitation of patients with hemorrhagic shock includes the initial bolus of 2 L of crystalloid solutions and then red blood cell (RBC) transfusion. Plasma products are transfused based on the laboratory documentation of coagulopathy. This approach emphasizes the use of crystalloids and RBCs to potentially improve cardiac output and oxygen delivery and delays the use of plasma. Recent reports in the literature have documented adverse effects of excessive crystalloid use and the independent association of RBC transfusion with increased mortality in critically ill patients. There is also a lack of evidence that the transfusion of stored RBCs improves oxygen consumption for patients with an oxygen debt or who are in shock. Current review articles describing damage control or hemostatic resuscitation principles, coupled with those describing the early coagulopathy of trauma, suggest a change from this classic approach maybe in order. Our objective in this study was to determine the effect of fresh frozen plasma (FFP) and RBC transfusion on in-hospital survival for patients with combat-related injuries who required any blood product administration.