Update and new developments in the management of the exsanguinating patient

Gordon A. Riha, Martin A. Schreiber

    Research output: Contribution to journalReview article

    6 Scopus citations

    Abstract

    Definitive management of the exsanguinating patient continues to challenge providers in multiple specialties. Significant hemorrhage may be encountered in a variety of patient care circumstances. Over the past two decades, the vast majority of data and evidence regarding transfusion in the exsanguinating patient has been based upon the trauma literature, and a large amount of recent research has investigated this subject area. In addition to the care of trauma patients, the data which have emerged can also be extrapolated to the treatment of nontrauma patients undergoing transfusion for major hemorrhage. The concept of massive transfusion is an evolving paradigm, and numerous investigations have challenged old principles while creating new controversies. The current review will examine the latest developments in the management of patients with profound hemorrhage. The challenges of dealing with the ''lethal triad'' will be discussed, as will the various aspects of damage control and hemostatic resuscitation. The latest literature and controversy regarding massive transfusions and massive transfusion protocols will be elucidated with inclusion of data from recent military experiences. Finally, adjuncts including the most recent advances in hemorrhage control, identification of early predictors for massive transfusion, and utilization of pharmacologic and complementary factor agent therapy will be discussed.

    Original languageEnglish (US)
    Pages (from-to)46-57
    Number of pages12
    JournalJournal of intensive care medicine
    Volume28
    Issue number1
    DOIs
    StatePublished - Jan 1 2013

    Keywords

    • Damage control
    • Hemorrhage
    • Hemostatic resuscitation
    • Massive transfusion
    • Massive transfusion protocol

    ASJC Scopus subject areas

    • Critical Care and Intensive Care Medicine

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