Critical Bleeding in Blunt Trauma Patients

Abstract

Trauma is a serious global health issue in Western Countries and the leading cause of death during the first four decades of life [1,2]. Because injury is frequent among the younger population, life-years lost are greater from injury (on average 36 years lost per death) than from cardiovascular or neoplastic disease [3,4]. In Italy, there are 1,143,305 trauma admissions every year (9.3% of all hospital admissions), with 25,038 (2.19%) trauma patients being admitted to intensive care units (ICUs) (data from Italian Ministry of Health). Trauma deaths before and after hospital admission are 18,000 per year. Acute blood loss has been reported to be the principal cause of immediate or early trauma death 5–8. In an autopsy study on 255 consecutive trauma deaths [9], hemorrhage alone or combined with severe head trauma, was the cause of death in 70% of cases. Significantly, most of these deaths occurred during the first phases of pre-hospital or hospital care. The length of time between injury and death was less than one hour in 66.5% and from 1 to 6 hours in 24.6% of cases. In European countries, owing to the prevalence of blunt trauma, causes of unstable hemodynamics are mainly pelvic ring and extremity fractures with extensive soft tissue destruction, followed by abdominal injuries (Fig. 1). Advances in trauma care, such as improved transportation systems, hypotensive resuscitation, strategies of damage control in emergency surgery, angiographic embolization procedures, all increase the chances of survival of the hemorrhagic patient. Nevertheless, hemodynamic instability often requires infusion of liters of crystalloid and colloid solutions and transfusion of several units of packed red cells, leading to consumption and dilution of clotting factors.