Acute Blood Loss During Burn and Soft Tissue Excisions: An Observational Study of Blood Product Resuscitation Practices and Focused Review
ARMY INST OF SURGICAL RESEARCH FORT SAM HOUSTON TX
Pagination or Media Count:
Many military and civilian centers have shifted to a damage-control resuscitation approach, focused on providing oxygen- carrying capacity while simultaneously mitigating coagulopathy with a balanced ratio of platelets and plasma to red blood cells. It is unclear to what degree this strategy is used during burn or soft tissue excision. Here, we characterized blood product transfusion during burn and soft tissue surgery and reviewed the published literature regarding intraoperative coagulation changes. We hypothesized that blood product resuscitation during burn and soft tissue excision is not hemostatic and would be insufficient to address hemorrhage-induced coagulopathy. Consented adult patients were enrolled into an institutional review board - approved prospective observational study. Number, component type, volume, and age of the blood products transfused were recorded during burn excisiongrafting or soft tissue debridement. Component bags packed red blood cells, fresh frozen plasma, platelets, and cryoprecipitate were collected, and the remaining sample was harvested from the bag and tubing. Aliquots of 11,000th the original volume of each blood product were obtained and combined, producing an amalgam sample containing the same ratio of product transfused. Platelet count, rotational thromboelastometry, and impedance aggregometry were measured. Significance was set at p less than 0.05. Amalgamated transfusate samples produced abnormally weak clots p less than or equal to 0.001 particularly if they did not contain platelets. Clot strength 48.8 2.6 mm reference range, 49 - 71 mm for platelet-containing amalgams was below the lower limit of the reference range despite platelet - red blood cell ratios greater than 11. Platelet aggregation was abnormally low transfused platelets were functionally inferior to native platelets.
- Anatomy and Physiology
- Medicine and Medical Research