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Postgraduate Education Corner: CONTEMPORARY REVIEWS IN CRITICAL CARE MEDICINE |

Massive Transfusion: New Insights

Kristen C. Sihler, MD, MS; Lena M. Napolitano, MD, FCCP
Author and Funding Information

Affiliations: From the University of Michigan School of Medicine, Ann Arbor, MI.

Correspondence to: Lena M. Napolitano, MD, FCCP, Professor of Surgery, Division Chief, Acute Care Surgery (Trauma, Burn, Critical Care, Emergency Surgery), Associate Chair, Department of Surgery, University of Michigan Health System, Room 1C421 University Hospital, 1500 East Medical Dr, Ann Arbor, MI 48109-0033; e-mail: lenan@umich.edu


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).


© 2009 American College of Chest Physicians


Chest. 2009;136(6):1654-1667. doi:10.1378/chest.09-0251
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Massive transfusion (MT) is used for the treatment of uncontrolled hemorrhage. Earlier definitive control of life-threatening hemorrhage has significantly improved patient outcomes, but MT is still required. A number of recent advances in the area of MT have emerged, including the use of “hypotensive” or “delayed” resuscitation for victims of penetrating trauma before hemorrhage is controlled and “hemostatic resuscitation” with increased use of plasma and platelet transfusions in an attempt to maintain coagulation. These advances include the earlier use of hemostatic blood products (plasma, platelets, and cryoprecipitate), recombinant factor VIIa as an adjunct to the treatment of dilutional and consumptive coagulopathy, and a reduction in the use of isotonic crystalloid resuscitation. MT protocols have been developed to simplify and standardize transfusion practices. The authors of recent studies have advocated a 1:1:1 ratio of packed RBCs to fresh frozen plasma to platelet transfusions in patients requiring MT to avoid dilutional and consumptive coagulopathy and thrombocytopenia, and this has been associated with decreased mortality in recent reports from combat and civilian trauma. Earlier assessment of the exact nature of abnormalities in hemostasis has also been advocated to direct specific component and pharmacologic therapy to restore hemostasis, particularly in the determination of ongoing fibrinolysis.

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