Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL, USA.
Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL, USA; Department of Surgery, University of South Florida, Tampa, FL, USA.
Am J Emerg Med. 2020 Dec;38(12):2661-2666. doi: 10.1016/j.ajem.2020.07.041. Epub 2020 Jul 22.
Acute blood loss in trauma requires quick identification and action to restore circulating volume and save the patient. Massive transfusion protocols (MTPs) have become standard at Trauma Centers, in order to rapidly deliver blood products to bleeding patients. This literature review presents current standards of transfusion ratios, as well as insights into adjuncts during massive transfusions.
PubMED was searched for articles from 2005 to 2020 on MTPs, the article were assessed for single vs. multi-institutional, mechanism of injury, type of MTP, timing in which blood products should be administered, timing of delivery of blood products to trauma bay, pre-hospital treatment and adjuncts, and outcomes.
Eleven studies addressed transfusion ratios. Seven studies looked at timing of blood products. Nine studies addressed MTP pre-hospital treatment and adjuncts. Prior to 2015, studies supported the benefits of a balanced transfusion ratio, which was then confirmed by the PROPPR randomized controlled trial. The shorter the time to blood product delivery the better the outcomes. New advances in technology have allowed us to measure different patterns of coagulation, allowing more individualized approaches to the bleeding patient.
Current massive transfusion protocols should utilize between 1:1:1 and 1:1:2 ratios of the 3 main products; plasma, platelets, and red blood cells. Massive transfusion protocols are effective in decreasing mortality. Better resuscitation efforts were seen when blood products were readily available in the trauma bay when the patient arrived and the faster the replacement of blood, the better the outcomes.
创伤导致的急性失血需要快速识别和采取行动，以恢复循环血量并拯救患者。大量输血方案（MTP）已成为创伤中心的标准，以便迅速向出血患者输送血液制品。本文献复习介绍了目前的输血比例标准，以及在大量输血期间的辅助治疗方法。
在 PubMed 上搜索了 2005 年至 2020 年关于 MTP 的文章，评估了这些文章的单中心与多中心研究、损伤机制、MTP 类型、应何时给予血液制品、血液制品送达创伤区的时间、院前治疗和辅助治疗以及结局。
有 11 项研究涉及输血比例，7 项研究探讨了血液制品的给予时间，9 项研究涉及 MTP 的院前治疗和辅助治疗。在 2015 年之前，研究支持平衡输血比例的益处，随后 PROPPR 随机对照试验证实了这一点。血液制品送达时间越短，结局越好。技术的新进展使我们能够测量不同的凝血模式，从而为出血患者提供更个体化的治疗方法。
目前的大量输血方案应使用 3 种主要制品（血浆、血小板和红细胞）的 1:1:1 至 1:1:2 比例。大量输血方案可有效降低死亡率。当患者到达创伤区时血液制品随时可用且血液制品的替代速度越快，复苏效果越好。
