Intraoperative blood salvage, when selectively used for cases involving large-volume blood loss, can provide a ready source of ongoing erythrocyte support for trauma patients. Devices designed for rapid blood infusion and selleck chem inhibitor blood warming can facilitate transfusion support and can mitigate complications of hypothermia.Pharmacologic support of hemostasisA large multicenter prospective trial has established that early use of an antifibrinolytic (tranexamic acid) reduced overall mortality in trauma patients, especially if administered within 3 hours of injury [19,20]. The incremental cost of tranexamic acid per life-year gained was just $64 [71]. In contrast, when tested in trauma trials, even multiple doses of rVIIa did not improve survival [17,18] and may have worsened outcomes due to an increased risk of arterial thrombosis [72-74].

The lack of clinical effectiveness and the extremely high cost of rVIIa relative to RBCs translate into a negligible cost-effectiveness for rVIIa.Transfusion support of hemostasisThe Consensus Panel felt that neither a strategy of transfusion support based solely on laboratory testing nor a strategy based solely on blood component ratios was demonstrated to result in optimal transfusion support for all trauma patients. A potential shortcoming of laboratory-directed therapy, as the only strategy for blood support in massive hemorrhage, is the potential to fall behind. This can result from reliance on assays with low sensitivity and predictive value for the hemostatic derangements among trauma patients, or from delays in test turnaround time.

A potential short-coming of ratio-driven blood support, as the only strategy of transfusion care, is overtransfusion with plasma and platelets resulting either in no benefit [75,76] or in added toxicity (especially pulmonary) [13,76-78]. The evidence supporting a 1:1:1 transfusion strategy in civilian trauma was not sufficiently strong to overcome concerns about its toxicity to patients, nor to recommend it as a standard of care in Canada. There was insufficient evidence to favor a panel of traditional tests over TEG?/ROTEM? tests or vice versa for guiding therapy. There was also insufficient information to favor point-of-care testing versus centralized testing.Because patients receiving large-volume transfusion support vary greatly in the nature and degree of injury, the panel wished to emphasize the importance of individual tailored therapy over rigid protocols of blood transfusion support.

In addition, treatment GSK-3 guidelines appropriate for severe trauma patients do not apply to elective surgery patients who experience significant hemorrhage. Patients undergoing elective surgery without shock, acidosis, and significant tissue injury do not experience the same degree of hemostatic breakdown observed in severe trauma.