Early identification of uncontrolled hemorrhage after trauma: Current status and future direction

2014 
D uring the last decade, advanced trauma care surgical and transfusion teams have achieved remarkable gains in the rapid identification and effective response to potentially lethal hemorrhage, and these improvements are now demonstrable in improved survival and decreased blood product use. However, uncontrolled hemorrhage remains the most common cause of potentially preventable death after both civilian and military trauma, and of those who survive to reach advanced care, half will die in the first 2 hours after admission. Changes in the types and proportions of blood product requirements are also driving changes in blood banking procedures for product testing, release, and delivery. It is likely that the next evolution in improved survival from traumatic injury will occur in the realm of en route care through the introduction of advanced capabilities at the point of injury and during aeromedical transport. However, the ability to move a rapid, accurate, and practical diagnostic capability into the field medical response and the aviation transport process remains an unrealized goal in modern trauma care. In this review, using large-scale transfusion requirements (so-called massive transfusion [MT]) as a surrogate marker for uncontrolled hemorrhage, we will examine the history and current status of efforts to rapidly identify bleeding casualties and predict the need for immediate hemorrhage control procedures and transfusion.
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