Massive Trauma and Resuscitation Strategies

Abstract

Massive trauma remains the leading cause of mortality among people aged younger than 45 years. In this review, we discuss the initial care and diagnosis of trauma patients followed by a comparison of resuscitation strategies. We discuss various strategies including use of whole blood and component therapy, examine viscoelastic techniques for management of coagulopathy, and consider the benefits and limitations of the resuscitation strategies and consider a series of questions that will be important for researchers to answer to provide the best and most cost-effective therapy for severely injured patients.

Keywords: Coagulopathy; Component therapy; Resuscitation; Trauma; Viscoelastic technique; Whole blood.

Figure 1.. Components of Rotational Thromboelastometry (ROTEM).

Representation of normal ROTEM evaluation of blood. Different analytic times, angles, and components are listed with abbreviations defined in the figure. Previously published materials that are unchanged from the source: “From Anderson L, Quasim I, Steven M, et al. Interoperator and intraoperator variability of whole blood coagulation assays: a comparison of thromboelastography and rotational thromboelastometry. J Cardiothorac Vasc Anesth. Dec 2014;28(6):1550-7. doi:10.1053/j.jvca.2014.05.023; with permission”.

Figure 2.. Components of Thromboelastography (TEG).

Representation of normal TEG evaluation of blood. Different analytic times, angles, and components are listed with abbreviations defined in the figure. Previously published materials that are unchanged from the source: “From Anderson L, Quasim I, Steven M, et al. Interoperator and intraoperator variability of whole blood coagulation assays: a comparison of thromboelastography and rotational thromboelastometry. J Cardiothorac Vasc Anesth. Dec 2014;28(6):1550-7. doi:10.1053/j.jvca.2014.05.023; with permission”.