Trauma-Induced Coagulopathy and Role of a Massive Transfusion Protocol in Trauma Anesthesia

The treatment of shock after trauma requires a systematic approach to rapidly and accurately diagnose injuries and institute therapy. Definitive control of hemorrhage is essential, together with restoration of adequate circulating blood volume. Use of a massive transfusion protocol (MTP) facilitates rapid availability of components in an increased ratio of plasma and platelets to packed red blood cells (RBCs). The PROPPR study (Pragmatic Randomized Optimal Platelet and Plasma Ratios) is investigating 1:1:1 versus 1:1:2 ratios of Plasma:Platelet:RBC products given to trauma patients who are predicted to require massive transfusions cetir-tmc.org/research/proppr. Point-of-care viscoelastic assays may allow for goal-directed therapy in trauma-induced coagulopathy (TIC) and massive transfusion, including the use of antifibrinolytics when appropriate. Unresolved issues remain, including use of fibrinogen and/or prothrombin complex concentrate, MTP use in blunt versus penetrating trauma, optimal transfusion ratios, and timing of blood component administration. Understanding the mechanism of hemorrhage is clearly required in order to...