Working Party on Clinical Transfusion，Chinese Society of Blood Transfusion
［Abstract］ Severe trauma is the main cause of death and disability，causing up to 8 million deaths worldwide every year，and traumatic hemorrhage is the leading cause of death among the injured persons． At present，there is still a lack of feasible standard of blood resuscitation for traumatic hemorrhage in China，which affects the prognosis of the injured persons． For this reason，the Working Party on Clinical Transfusion，Chinese Society of Blood Transfusion has formulated expert consensus on patient blood management for traumatic hemorrhage( 2022 edition) ，emphasizing that patient blood management for traumatic hemorrhage must be based on correct damage control resuscitation，and the management of platelets and coagulation factors must be paid attention to． This expert consensus establishes a practical massive transfusion protocol for traumatic hemorrhage patients．
The role of thromboelastography in expert consensus on blood management in patients with traumatic bleeding:
Regarding the implementation of MTP, the conditions for the initiation of MTP are the hemodynamic changes caused by traumatic hemorrhage, that is, the heart rate ≥ 110 beats/min and the systolic blood pressure ≤ 90 mmHg. The specific implementation method is shown in Figure 1. The release time of blood components in MTP: (1) If the blood pressure of the injured person is within the blood pressure range permitted by the controlled hypotension resuscitation technology, the first bag of RBC and fresh frozen plasma (FFP) should be started 30 minutes after starting MTP issue. (2) If the blood pressure of the injured person is lower than the low value allowed by the controlled hypotension resuscitation technique, the sooner the first bag of RBC and FFP can be sent out, the better. Since ATC mainly occurs in the early stage of trauma, we recommend transfusion according to RBC: FFP = 1: 1 in the early stage of trauma, and various blood components should be transfused according to the corresponding indications after the relevant test report, the purpose is to make the whole blood resuscitation process. The input RBC:FFP is between 2:1 and 1:1.
Traumatic hemorrhage with hemodynamic changes, check the trauma hemorrhage package (P;T, Hb, PT, APTT, Fig, INR, and thrombelastography should be properly checked) every 30-60 minutes if necessary , 1 g of TXA was injected intravenously to the trauma within 3 hours, and repeated if necessary, injecting RBC4U and FFP4U.
Severe trauma kills 6 to 8 million people worldwide every year, and the main cause of death is traumatic hemorrhage . Therefore, blood resuscitation has become an important means to rescue trauma, especially severe trauma. Patient blood management is the use of evidence-based multidisciplinary means, through reducing blood loss, promoting hematopoiesis, reducing unnecessary blood transfusion and other methods, so as to achieve the purpose of improving patient prognosis .
references:
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