Haemotherapy algorithm for the management of trauma-induced coagulopathy: an Australian perspective

Winearls, James, Mitra, Biswadev and Reade, Michael C. (2017) Haemotherapy algorithm for the management of trauma-induced coagulopathy: an Australian perspective. Current Opinion in Anaesthesiology, 30 2: 265-276. doi:10.1097/ACO.0000000000000447


Author Winearls, James
Mitra, Biswadev
Reade, Michael C.
Title Haemotherapy algorithm for the management of trauma-induced coagulopathy: an Australian perspective
Journal name Current Opinion in Anaesthesiology   Check publisher's open access policy
ISSN 1473-6500
0952-7907
Publication date 2017-04-01
Year available 2017
Sub-type Article (original research)
DOI 10.1097/ACO.0000000000000447
Open Access Status Not yet assessed
Volume 30
Issue 2
Start page 265
End page 276
Total pages 12
Place of publication Philadelphia, PA United States
Publisher Lippincott Williams & Wilkins
Language eng
Subject 2703 Anesthesiology and Pain Medicine
Abstract Purpose of review Recent advances in the understanding of the pathophysiological processes associated with traumatic haemorrhage and trauma-induced coagulopathy have resulted in improved outcomes for seriously injured trauma patients. However, a significant number of trauma patients still die from haemorrhage. This article reviews the various transfusion strategies utilized in the management of traumatic haemorrhage and describes the major haemorrhage protocol (MHP) strategy employed by an Australian trauma centre. Recent findings Few topics in trauma resuscitation incite as much debate and controversy as to what constitutes the 'ideal' MHP. There is a widespread geographical and institutional variation in clinical practice. Three strategies are commonly utilized; fixed ratio major haemorrhage protocol (FRMHP), viscoelastic haemostatic assay (VHA)-guided MHP and hybrid MHP. The majority of trauma centres utilize an FRMHP and there is highlevel evidence to support the use of high blood product ratios. It can be argued that the FRMHP is too simplistic to be applied to all trauma patients and that the use of VHA-guided MHP with predominant factor concentrate transfusion can allow rapid individualized interventions. In between these two strategies is a hybrid MHP, combining early FRMHP with subsequent VHA-guided transfusion. Summary There are advantages and disadvantages to each of the various MHP strategies and the evidence base to support one above another with any certainty is lacking at this time. One strategy cannot be considered superior to the other and the choice of MHP is dependent on interpretation of the current literature and local institutional logistical considerations. A number of exciting studies are currently underway that will certainly increase the evidence base and help inform clinical practice.
Formatted abstract
Purpose of review: Recent advances in the understanding of the pathophysiological processes associated with traumatic haemorrhage and trauma-induced coagulopathy have resulted in improved outcomes for seriously injured trauma patients. However, a significant number of trauma patients still die from haemorrhage. This article reviews the various transfusion strategies utilized in the management of traumatic haemorrhage and describes the major haemorrhage protocol (MHP) strategy employed by an Australian trauma centre.

Recent findings: Few topics in trauma resuscitation incite as much debate and controversy as to what constitutes the ‘ideal’ MHP. There is a widespread geographical and institutional variation in clinical practice. Three strategies are commonly utilized; fixed ratio major haemorrhage protocol (FRMHP), viscoelastic haemostatic assay (VHA)-guided MHP and hybrid MHP. The majority of trauma centres utilize an FRMHP and there is high-level evidence to support the use of high blood product ratios. It can be argued that the FRMHP is too simplistic to be applied to all trauma patients and that the use of VHA-guided MHP with predominant factor concentrate transfusion can allow rapid individualized interventions. In between these two strategies is a hybrid MHP, combining early FRMHP with subsequent VHA-guided transfusion.

Summary: There are advantages and disadvantages to each of the various MHP strategies and the evidence base to support one above another with any certainty is lacking at this time. One strategy cannot be considered superior to the other and the choice of MHP is dependent on interpretation of the current literature and local institutional logistical considerations. A number of exciting studies are currently underway that will certainly increase the evidence base and help inform clinical practice.
Keyword Major haemorrhage protocol
Transfusion
Trauma
Trauma-induced coagulopathy
Viscoelastic haemostatic assays
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
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