An update on hemostatic resuscitation from qocsuing's blog

An update on hemostatic resuscitation

Many traumatic events may prompt the need for hemostatic resuscitation. According to James R. Stubbs, M.D., the chair of Transfusion Medicine at Mayo Clinic's campus in Rochester, Minnesota, some of the most common events include blunt force trauma, such as from motor vehicle collisions, or severe falls, such as falling off the roof of a building.To get more news about carboxymethyl chitosan hemostatic agent, you can visit rusuntacmed.com official website.

The nature of these types of injuries may lead to blood loss and blood-clotting issues. For people who are severely injured, professionals need to provide support to maintain perfusion.

Hemorrhagic shock remains the most common indication for hemostatic resuscitation, along with instances where providers see a patient is moving toward shock and want to prevent hypotension.

Though trauma as a medical field often studies hemostatic resuscitation and thus its practice is highly data driven, the methods apply for any kind of hemorrhage, says Martin D. Zielinski, M.D., a trauma surgeon at Mayo Clinic in Minnesota.Hemostatic resuscitation today differs from methods used previously. Now, the preferred method involves starting with transfusion therapy early in treatment to provide volume support, plasma and platelets, and support for hemostasis.

"The old method was if the patient required blood volume replacement, you gave clear fluids — large volumes of normal saline or lactated Ringer's solution," says Dr. Stubbs. "If the patient did not respond satisfactorily to volume replacement with clear fluids, red cell transfusions would be added to the resuscitation effort to augment blood volume replacement and improve oxygen-carrying capacity."

Studies found that large crystalloid volumes were detrimental to patients and led to volume overload, according to Dr. Stubbs. Negative outcomes include dilutional coagulopathy, acidosis, hypothermia and abdominal compartment syndrome.

"They were just volume replacement, not treatment of hemorrhagic shock features," says Dr. Zielinski. "Perfusion is maintained, but oxygenation is not."

Today's method, called damage control resuscitation (DCR), involves early aggregate replacement of red cell mass and hemostasis, red blood cells, plasma and platelets, or whole blood, which Dr. Stubbs notes may be easier to administer in a prehospital environment.

Another key aspect of DCR is tourniquet control, says Dr. Zielinski, including local pressure on an extremity or operative control on a truncal wound.Dr. Stubbs says there's a movement toward the refrigeration strategy, and experts in transfusion medicine are trying to convince the Food and Drug Administration (FDA) of its efficacy and benefits. He says that the South Texas Blood & Tissue Center successfully argued that because of the critical access hospitals they support, the center needed cold-stored platelets. This center received a special license from the FDA to manufacture cold platelets where standard platelets aren't available.

Dr. Stubbs advocates that small hospitals nationwide consider this process to provide platelets for trauma patients with severe injuries. The FDA issued Mayo Clinic's campus in Rochester, Minnesota, a variance to store refrigerated platelets for 14 days. Not only does this extend use of the platelets, but because prehospitalists can store platelets in a cooler, staff can keep platelets with red blood cells and plasma in ambulances, allowing for remote DCR.