Injury is rapidly becoming the leading cause of death worldwide, and uncontrolled
hemorrhage is the leading cause of potentially preventable death. In addition to
crystalloid and/or
colloid based
resuscitation, severely injured
trauma patients are routinely transfused RBCs, plasma, platelets, and in some centers either cryoprecipitate or
fibrinogen concentrates or whole blood. Optimal timing and quantity of these products in the treatment of hypothermic, coagulopathic and acidotic
trauma patients is unclear. The immediate availability of these components is important, as most hemorrhagic deaths occur within the first 3-6h of patient arrival. While there are strongly held opinions and longstanding traditions in their use, there are little data within which to logically guide
resuscitation therapy. Many current recommendations are based on euvolemic elective surgery patients and incorporate laboratory data parameters not widely available in the first few minutes after patient arrival. Finally, blood components themselves have evolved over the last 30 years, with great attention paid to product safety and inventory management, yet there are surprisingly limited clinical outcome data describing the long term effects of these changes, or how the components have improved clinical outcomes compared to whole blood
therapy. When focused on survival of the rapidly
bleeding trauma patient, it is unclear if current component
therapy is equivalent to whole
blood transfusion. In fact data from the current war in Iraq and Afghanistan suggest otherwise. All of these factors have contributed to the current situation, whereby blood component
therapy is highly variable and not driven by long term patient outcomes. This review will address the issues raised above and describe recent
trauma patient outcome data utilizing predetermined plasma:platelet:RBC transfusion ratios and an ongoing prospective observational
trauma transfusion study.