If not now, when? The value of the MTP in managing massive bleeding

Abstract

Preview
There is mounting evidence that providing blood transfusion to trauma patients as soon as possible -well within the first hour after injury- improves the odds of survival. A recent randomised controlled trial of severely wounded civilian trauma patients with relatively long helicopter transport times from the scene of the accident to the hospital showed that adding plasma to the standard of care reduced mortality at 30-days compared to receiving the standard of care alone1. Interestingly, a secondary analysis of these data revealed that receipt of any blood product, RBCs alone, plasma alone, or a combination of these two products, produced superior survival compared to receipt of crystalloid alone2. There are similar data in favour of early transfusion from the military3; a study of 502 combat casualties demonstrated that the provision RBCs, plasma, or a combination of these two products within 15 minutes of MEDEVAC rescue improved both 24 hour and 30 day survival compared to patients who did not receive any blood products or who received them later in the resuscitation. Available data also suggest that replacing the functionality of the patient’s lost whole blood with either whole blood, or a mixture of RBCs, plasma, platelets and cryoprecipitate, is likely to improve outcomes compared to transfusion of mostly RBCs with little to no plasma or platelets4. Development of the optimal combination of blood products remains an active area of research. [ … ]