Advertisement

New frontiers in critical bleeding

  • S. Busani
  • L. Donno
  • M. Girardis

Abstract

The exact definition of critical haemorrhage remains a matter of debate, but the majority view is that it can be defined as bleeding requiring emergency intervention to avoid the patient’s death or tissue/organ loss (e.g. liver, uterus) [1]–[3]. The first step in critical haemorrhage is the control of bleeding source by means of surgery, radiological or endoscopic intervention and medical therapy in patients with inherited or acquired coagulopathies. Unfortunately, these strategies are sometimes not available or do not allow definitive control of bleeding, particularly in the case of severe trauma patients. In fact, massive bleeding remains one of the main causes of death in trauma patients, and it is usually caused by a combination of vascular injury and coagulopathy [4]. In these patients, together with diffuse injuries, secondary coagulopathy is a key factor in failed bleeding control. The causes of this coagulopathy are multifactorial, and both hypothermia and acidosis can worsen haemostasis function further [4]–[5]. Cosgriff et al. [6] indicate that trauma patients transfused with more than 10 units of packed red blood cells and the combination of injury severity score >25, pH<7.10, temperature <34°C and systolic blood pressure <70mmHg have a 98% chance of developing a severe coagulopathy (PT and aPTT twice the normal values). Among these different risk factors, hypothermia and acidosis have been identified as the two main ones involved in the development of coagulopathy [6].

Keywords

Trauma Patient Injury Severity Score Severe Coagulopathy Injure Trauma Patient Severe Trauma Patient 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Santoso JT, Saunders BA, Grosshart K (2005) Massive blood loss and transfusion in obstetrics and gynecology. Obstet Gynecol Surv 12:827–837CrossRefGoogle Scholar
  2. 2.
    Erber WN (2002) Massive blood transfusion in the elective surgical setting. Transfus Apher Sci 27:83–92PubMedCrossRefGoogle Scholar
  3. 3.
    Stainsby D, MacLennan S, Hamilton PJ (2000) Management of massive blood loss: a template guide. Br J Anaesth 85:487–491PubMedGoogle Scholar
  4. 4.
    Spahn DR, Rossaint R (2005) Coagulopathy and blood component in trauma. Br J Anaesth 95:130–139PubMedCrossRefGoogle Scholar
  5. 5.
    Schreiber MA (2005) Coagulopathy in the trauma patient. Curr Opin Crit Care 11:590–597PubMedCrossRefGoogle Scholar
  6. 6.
    Cosgriff N, Moore EE, Sauaia A (1997) Predicting life-threatening coagulopathy in the massively transfused trauma patient: hypothermia and acidosis revisited. J Trauma 42:857–862PubMedGoogle Scholar
  7. 7.
    Marietta M, Facchini L, Pedrazzi P et al (2006) Pathophysiology of bleeding in surgery. Transplant Proc 38:812–814PubMedCrossRefGoogle Scholar
  8. 8.
    Eddy VA, Morris JA, Culliname DC (2000) Hypothermia, coagulopathy, acidosis. Surg Clin North Am 80:845–854PubMedCrossRefGoogle Scholar
  9. 9.
    Wolberg AS, Meng ZH, Monroe DM, Hoffman M (2004) A systematic evaluation of the effect of temperature on coagulation enzyme activity and platelet function. J Trauma 56:1221–1228PubMedGoogle Scholar
  10. 10.
    Lynn M, Jeroukhimov I, Klein Y, Martinowitz U (2002) Updates in the management of severe coagulopathy in trauma patients. Intensive Care Med 28:S241–S247PubMedCrossRefGoogle Scholar
  11. 11.
    Meng ZH, Wolberg AS, Monroe DM, Hoffman M (2003) The effect of temperature and pH on the activity of factor VIIa: implications for the efficacy of high-dose factor VIIa in hypothermic and acidotic patients. J Trauma 55:886–891PubMedGoogle Scholar
  12. 12.
    Hess JR, Lawson JH (2006) The coagulopathy of trauma versus disseminated intravascular coagulation. J Trauma 60:S12–S19PubMedGoogle Scholar
  13. 13.
    Ostomel TA, Stoimenov PK, Holden PA et al (2006) Host-guest composites for induced hemostasis and therapeutic healing in traumatic injuries. J Thromb Thrombolysis 22:55–67PubMedCrossRefGoogle Scholar
  14. 14.
    Alam HB, Uy GB, Miller D (2003) Comparative analysis of hemostatic agents in a swine model of lethal growing injury. J Trauma 54:1077–1082PubMedCrossRefGoogle Scholar
  15. 15.
    Wright FL, Hua HT, Velhamos G et al (2004) Intracorporeal use of hemostatic agent QuickClot in a coagulopathic patient with combined thoracoabdominal penetrating trauma. J Trauma 56:205–208PubMedCrossRefGoogle Scholar
  16. 16.
    Gurdeep S, Harvinder S, Philip R, Amanjit K (2006) Intranasal use of QuickClot in a patient with uncontrollable epistaxis. Med J Malaysia 61:112–113PubMedGoogle Scholar
  17. 17.
    Neuffer MC, McDivitt J, Rose D et al (2004) Hemostatic dressings for the first responder: a review. Mil Med 169:716–720PubMedGoogle Scholar
  18. 18.
    Wedmore I, McManus JG, Pusateri AE, Holcomb JB (2006) A special report on the chitosan-based hemostatic dressing: experience in current combat operations. J Trauma 60:655–658PubMedGoogle Scholar
  19. 19.
    Jewelewicz DD, Cohn SM, Proctor KG (2003) Modified rapid deployment haemostat bandage reduces blood loss and mortality in coagulopathic pigs with severe liver injury. J Trauma 55:275–281PubMedGoogle Scholar
  20. 20.
    King DR, Cohn SM, Proctor KG for the Miami Clinical Trials Group (2004) Modified rapid deployment haemostat bandage terminates bleeding in coagulopathic patients with severe visceral injuries. J Trauma 57:756–759PubMedCrossRefGoogle Scholar
  21. 21.
    Levi M, Cromheecke ME, de Jonge E et al (1999) Pharmacological strategies to decrease excessive blood loss in cardiac surgery: a meta-analysis of clinically relevant endpoints. Lancet 354:1940–1947PubMedCrossRefGoogle Scholar
  22. 22.
    Grounds M (2003) Recombinant factor VIIa and its use in severe bleeding in surgery and trauma: a review. Blood Rev 17:S11–S21PubMedCrossRefGoogle Scholar
  23. 23.
    Ghorashian S, Beverly JH (2004) Off license use of recombinant activated factor VII. Blood Rev 18:245–259PubMedCrossRefGoogle Scholar
  24. 24.
    Boffard KD, Riou B, Warren B et al (2005) Novoseven Trauma Study Group. Recombinant factor VIIa as adjunctive therapy for bleeding control in severely injured trauma patients: two parallel randomized, placebo-controlled, double-blind clinical trials. J Trauma 59:8–15PubMedGoogle Scholar
  25. 25.
    Brott T, Broderick J, Kothari R et al (1997) Early hemorrhage growth in patients with intracerebral hemorrhage. Stroke 28:1–5PubMedGoogle Scholar
  26. 26.
    Mayer SA, Brun NC, Begtrup K et al (2005) Recombinant Activated Factor VII Intracerebral Hemorrhage Trial Investigators. Recombinant activated factor VII for acute intracerebral hemorrhage. N Engl J Med 352:777–785PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2007

Authors and Affiliations

  • S. Busani
    • 1
  • L. Donno
    • 1
  • M. Girardis
    • 1
  1. 1.Anaesthesia and Intensive Care Unit IModena University Hospital and Modena and Reggio Emilia UniversityItaly

Personalised recommendations