Lee Jae Hyuk, Ward Kevin R
Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
Department of Emergency Medicine, Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, Ann Arbor, MI, USA.
Clin Exp Emerg Med. 2024 Mar;11(1):9-21. doi: 10.15441/ceem.23.127. Epub 2024 Mar 21.
This review explores the concept of "blood failure" in traumatic injury, which arises from the interplay of oxygen debt, the endotheliopathy of trauma (EoT), and acute traumatic coagulopathy (ATC). Traumatic hemorrhage leads to the accumulation of oxygen debt, which can further exacerbate hemorrhage by triggering a cascade of events when severe. Such events include EoT, characterized by endothelial glycocalyx damage, and ATC, involving platelet dysfunction, fibrinogen depletion, and dysregulated fibrinolysis. To manage blood failure effectively, a multifaceted approach is crucial. Damage control resuscitation strategies such as use of permissive hypotension, early hemorrhage control, and aggressive transfusion of blood products including whole blood aim to minimize oxygen debt and promote its repayment while addressing endothelial damage and coagulation. Transfusions of red blood cells, plasma, and platelets, as well as the use of tranexamic acid, play key roles in hemostasis and countering ATC. Whole blood, whether fresh or cold-stored, is emerging as a promising option to address multiple needs in traumatic hemorrhage. This review underscores the intricate relationships between oxygen debt, EoT, and ATC and highlights the importance of comprehensive, integrated strategies in the management of traumatic hemorrhage to prevent blood failure. A multidisciplinary approach is essential to address these interconnected factors effectively and to improve patient outcomes.
本综述探讨了创伤性损伤中“血液衰竭”的概念，它源于氧债、创伤性内皮病变（EoT）和急性创伤性凝血病（ATC）之间的相互作用。创伤性出血导致氧债的积累，严重时可通过引发一系列事件进一步加重出血。这些事件包括以内皮糖萼损伤为特征的EoT和涉及血小板功能障碍、纤维蛋白原消耗及纤维蛋白溶解失调的ATC。为有效管理血液衰竭，多方面的方法至关重要。损伤控制复苏策略，如采用允许性低血压、早期出血控制以及积极输注包括全血在内的血液制品，旨在尽量减少氧债并促进其偿还，同时解决内皮损伤和凝血问题。输注红细胞、血浆和血小板以及使用氨甲环酸在止血和对抗ATC方面发挥关键作用。全血，无论是新鲜的还是冷藏的，正成为满足创伤性出血多种需求的一个有前景的选择。本综述强调了氧债、EoT和ATC之间的复杂关系，并突出了综合、一体化策略在创伤性出血管理中预防血液衰竭的重要性。多学科方法对于有效解决这些相互关联的因素并改善患者预后至关重要。
