• Hemostatics
• extracellular vesicles
• hemostasis
• platelet aggregation

• Hemostasis/drug effects
• Humans
• Cell-Derived Microparticles/metabolism
• Platelet Aggregation/drug effects
• Erythrocytes/drug effects
• Erythrocytes/metabolism
• Platelet Aggregation Inhibitors/pharmacology
• Blood Coagulation/drug effects
• Blood Coagulation/physiology
• Thrombelastography/methods
• Ticagrelor/pharmacology
• Pressure
• Eptifibatide/pharmacology
• Hemostatics/pharmacology
• Male

• 9JK08 James and Esther King Biomedical Research Program

• damage control resuscitation
• hemorrhage control resuscitation
• laboratory-guided transfusion therapy

• Humans
• Time Factors
• Hemorrhage/diagnosis
• Emergency Service, Hospital
• Blood Coagulation Tests
• Platelet Count
• Prothrombin Time

• hemorrhage control
• hemostatic agent
• local hemostatic agent
• surgery
• trauma

• Admission blood glucose
• Coagulopathy
• Hyperglycaemia
• Multiple trauma

• Humans
• Retrospective Studies
• Male
• Female
• Blood Coagulation Disorders/etiology
• Blood Coagulation Disorders/blood
• Blood Coagulation Disorders/mortality
• Middle Aged
• Blood Glucose/metabolism
• Blood Glucose/analysis
• Adult
• Multiple Trauma/complications
• Multiple Trauma/mortality
• Multiple Trauma/blood
• Risk Factors
• Trauma Centers
• Hyperglycemia/blood
• Hyperglycemia/complications
• Prognosis
• Injury Severity Score
• Predictive Value of Tests
• Aged
• ROC Curve

• Medizinische Hochschule Hannover (MHH) (3118)

• hemorrhage
• point-of-care diagnostics
• transfusion therapy

• Humans
• Dogs
• Animals
• Erythrocyte Transfusion/veterinary
• Retrospective Studies
• Bicarbonates
• Hospitals, Animal
• Hospitals, Teaching
• Hemoperitoneum/complications
• Hemoperitoneum/veterinary
• Hospitalization
• Lactates
• Blood Proteins
• Dog Diseases/diagnosis
• Dog Diseases/therapy

• PPH
• ROTEM
• TEG

• Blood coagulation
• hemostasis
• shock
• thrombelastography
• trauma

• blood clot
• hydrogel
• wound healing

• R35 GM138193 NIGMS NIH HHS

Background: White blood cell (WBC) subtypes have been suggested to reflect patients’ immune-inflammatory status. Furthermore, the derived ratio of platelets and WBC subtypes, including monocyte-to-lymphocyte ratio (MLR), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR), is proposed to be associated with patient outcome. Therefore, this study aimed to identify the association of platelets and white blood cells subtypes with the mortality outcome of trauma patients in the intensive care unit (ICU). Method: The medical information from 2854 adult trauma patients admitted to the ICU between 1 January 2009 and 31 December 2019 were retrospectively retrieved from the Trauma Registry System and classified into two groups: the survivors group (n = 2524) and the death group (n = 330). The levels of monocytes, neutrophils, lymphocytes, platelets, and blood-drawn laboratory data detected upon patient arrival to the emergency room and the derived MLR, NLR, and PLR were calculated. Multivariate logistic regression analysis was used to determine the independent effects of univariate predictive variables on mortality occurrence. Result: The results revealed the patients who died had significantly lower platelet counts (175,842 ± 61,713 vs. 206,890 ± 69,006/μL, p < 0.001) but higher levels of lymphocytes (2458 ± 1940 vs. 1971 ± 1453/μL, p < 0.001) than the surviving patients. However, monocyte and neutrophil levels were not significantly different between the death and survivor groups. Moreover, dead patients had a significantly lower PLR than survivors (124.3 ± 110.3 vs. 150.6 ± 106.5, p < 0.001). However, there was no significant difference in MLR or NLR between the dead patients and the survivors. Multivariate logistic regression revealed that male gender, old age, pre-existing hypertension, coronary artery disease and end-stage renal disease, lower Glasgow Coma Scale (GCS), higher Injury Severity Score (ISS), higher level of lymphocytes and lower level of red blood cells and platelets, longer activated partial thromboplastin time (aPTT), and lower level of PLR were independent risk factors associated with higher odds of trauma patient mortality outcome in the ICU. Conclusion: This study revealed that a higher lymphocyte count, lower platelet count, and a lower PLR were associated with higher risk of death in ICU trauma patients.

• intensive care unit
• monocyte-to-lymphocyte ratio
• neutrophil-to-lymphocyte ratio
• platelet-to-lymphocyte ratio
• white blood cell

• Chinese
• Coagulation test
• Coagulopathy
• Reference interval
• Thromboelastography
• Viscoelasticity

• haematology (incl blood transfusion)
• resuscitation
• trauma

• Amputation, Traumatic/physiopathology
• Amputation, Traumatic/rehabilitation
• Amputation, Traumatic/therapy
• Blood Coagulation Disorders/physiopathology
• Blood Coagulation Disorders/therapy
• Blood Transfusion
• Child, Preschool
• Critical Care
• Emergency Treatment/instrumentation
• Hemostasis
• Humans
• Lower Extremity/injuries
• Lower Extremity/physiopathology
• Male
• Rural Population
• Shock, Hemorrhagic/diagnosis
• Shock, Hemorrhagic/physiopathology
• Shock, Hemorrhagic/therapy
• Thrombelastography
• Treatment Outcome

Synthetic poly(vinyl alcohol)–chitosan as a new type of highly efficient hemostatic sponge with blood-triggered swelling and high biocompatibility.

The reverse shock index (rSI) multiplied by Glasgow Coma Scale (GCS) score (rSIG), calculated by multiplying the GCS score with systolic blood pressure (SBP)/hear rate (HR), was proposed to be a reliable triage tool for identifying risk of in-hospital mortality in trauma patients. This study was designed to externally validate the accuracy of the rSIG in the prediction of mortality in our cohort of trauma patients, in comparison with those that were predicted by the Revised Trauma Score (RTS), shock index (SI), and Trauma and Injury Severity Score (TRISS). Adult trauma patients aged ≥20 years who were admitted to the hospital from 1 January 2009 to 31 December 2017, were included in this study. The rSIG, RTS, and SI were calculated according to the initial vital signs and GCS scores of patients upon arrival at the emergency department (ED). The end-point of primary outcome is in-hospital mortality. Discriminative power of each score to predict mortality was measured using area under the curve (AUC) by plotting the receiver operating characteristic (ROC) curve for 18,750 adult trauma patients, comprising 2438 patients with isolated head injury (only head Abbreviated Injury Scale (AIS) ≥ 2) and 16,312 without head injury (head AIS ≤ 1). The predictive accuracy of rSIG was significantly lower than that of RTS in all trauma patients (AUC 0.83 vs. AUC 0.85, p = 0.02) and in patients with isolated head injury (AUC 0.82 vs. AUC 0.85, p = 0.02). For patients without head injury, no difference was observed in the predictive accuracy between rSIG and RTS (AUC 0.83 vs. AUC 0.83, p = 0.97). Based on the cutoff value of 14.0, the rSIG can predict the probability of dying in trauma patients without head injury with a sensitivity of 61.5% and specificity of 94.5%. The predictive accuracy of both rSIG and RTS is significantly poorer than that of TRISS, in all trauma patients (AUC 0.93) or in patients with (AUC 0.89) and without head injury (AUC 0.92). In addition, SI had the significantly worse predictive accuracy than all of the other three models in all trauma patients (AUC 0.57), and the patients with (AUC 0.53) or without (AUC 0.63) head injury. This study revealed that rSIG had a significantly higher predictive accuracy of mortality than SI in all of the studied population but a lower predictive accuracy of mortality than RTS in all adult trauma patients and in adult patients with isolated head injury. In addition, in the adult patients without head injury, rSIG had a similar performance as RTS to the predictive risk of mortality of the patients.

• Glasgow Coma Scale (GCS)
• Injury Severity Score (ISS)
• Revised Trauma Score (RTS)
• mortality
• shock index (SI)
• the Trauma and Injury Severity Score (TRISS)
• the rSI multiplied by GCS score (rSIG)

Platelet transfusion is a common practice to prevent spontaneous bleeding or bleeding due to invasive procedures. Transfusion of allogeneic blood components is associated with increased mortality and a worse clinical outcome. The clot strength is assessed by thromboelastometry and determined by the interaction between platelets and fibrinogen. The compensatory effect of high levels of fibrinogen on clot strength in patients with thrombocytopenia has been demonstrated in different clinical settings including sepsis. We report the case of a patient with severe thrombocytopenia whose thromboelastometry showed clot strength that was compensated for by the increase in plasma fibrinogen levels as an acute phase reactant of septic patients. Here, we report a case of a 62-year-old female diagnosed with bone marrow aplasia admitted in the intensive care unit with septic shock and severe thrombocytopenia. During the first 24 hours in the intensive care unit, she presented acute respiratory insufficiency and circulatory shock. The use of invasive mechanical ventilation and norepinephrine was required. Her chest X-ray showed bilateral lung injury. Thus, bronchoscopy with bronchoalveolar lavage was requested. Thromboelastometry was performed and resulted in a normal coagulable profile. Despite severe thrombocytopenia (1,000/mm³⁾, fibrinogen levels were increased (1,050mg/dL) due to septic shock. Bronchoscopy was performed without any active or further bleeding. Here, we report the use of thromboelastometry in the diagnosis of coagulation disorders, preventing unnecessary prophylactic platelet transfusion.

Transfusion therapy is associated with increased morbidity, mortality and costs. Conventional coagulation tests (CCT) are weak bleeding predictors, poorly reflecting coagulation in vivo. Thromboelastometry (ROTEM) provides early identification of coagulation disorders and can guide transfusion therapy by goals, reducing blood components transfusion.

The aim of this study is to describe coagulation profile of critically ill patients using ROTEM and evaluate the association between CCT and thromboelastometry.

This is a retrospective, observational study conducted in medical-surgical intensive care unit (ICU). Adult patients (≥18 years) admitted to ICU between November 2012 and December 2014, in whom ROTEM analyses were performed for bleeding management were included in this study. The first ROTEM and CCT after ICU admission were recorded simultaneously. Additionally, we collected data on blood components transfusion and hemostatic agents immediately after laboratory tests results.

The study included 531 patients. Most ROTEM tests showed normal coagulation profile [INTEM (54.8%), EXTEM (54.1%) and FIBTEM (53.3%)] with divergent results in relation to CCT: low platelet count (51.8% in INTEM and 55.9% in EXTEM); prolonged aPTT (69.9% in INTEM and 63.7% in EXTEM) and higher INR (23.8% in INTEM and 27.4% in EXTEM). However 16,7% of patients with normocoagulability in ROTEM received platelet concentrates and 10% fresh frozen plasma.

The predominant ROTEM profile observed in this sample of critically ill patients was normal. In contrast, CCT suggested coagulopathy leading to a possibly unnecessary allogenic blood component transfusion. ROTEM test may avoid inappropriate allogeneic blood products transfusion in these patients.

• Aged
• Blood Transfusion
• Critical Care
• Critical Illness
• Female
• Hemorrhage/diagnosis
• Hemorrhage/therapy
• Hemostatics/therapeutic use
• Humans
• Male
• Middle Aged
• Retrospective Studies
• Thrombelastography

Using extracorporeal membrane oxygenation (ECMO) to provide advanced life support in adult trauma patients remains a controversial issue now. The study was aimed at identifying the independent predictors of hospital mortality in adult trauma patients receiving ECMO for advanced cardiopulmonary dysfunctions.

This retrospective study enrolled 36 adult trauma patients receiving ECMO due to advanced shock or respiratory failure in a level I trauma center between August 2006 and October 2014. Variables collected for analysis were demographics, serum biomarkers, characteristics of trauma, injury severity score (ISS), damage-control interventions, indications of ECMO, and associated complications. The outcomes were hospital mortality and hemorrhage on ECMO. The multivariate logistic regression method was used to identify the independent prognostic predictors for the outcomes.

The medians of age and ISS were 36 (27–49) years and 29 (19–45). Twenty-three patients received damage-control interventions before ECMO. Among the 36 trauma patients, 14 received ECMO due to shock and 22 for respiratory failure. The complications of ECMO are major hemorrhages (n = 12), acute renal failure requiring hemodialysis (n = 10), and major brain events (n = 7). There were 15 patients died in hospital, and 9 of them were in the shock group.

The severity of trauma and the type of cardiopulmonary dysfunction significantly affected the outcomes of ECMO used for sustaining patients with post-traumatic cardiopulmonary dysfunction. Hemorrhage on ECMO remained a concern while the device was required soon after trauma, although a heparin-minimized protocol was adopted.

This study reported a health care intervention on human participants and was retrospectively registered. The Chang Gung Medical Foundation Institutional Review Board approved the study (no. 201601610B0) on December 12, 2016. All of the data were extracted from December 14, 2016, to March 31, 2017.

• Bleeding shock
• Extracorporeal life support
• Post-traumatic acute respiratory distress syndrome
• Post-traumatic cardiac arrest

To evaluate the parameters of the thrombin generation test (TGT) in coronary artery disease (CAD) patients on prolonged aspirin therapy during on-pump coronary artery bypass grafting (CABG) after donor platelet concentrate transfusion. A total of 148 patients with CAD on prolonged aspirin therapy (75–100 mg/day) who have undergone elective on-pump CABG were consecutively included in the study. Patients were divided randomly into two groups. Group 1 (n = 76) received donor platelet transfusions after cardiopulmonary bypass, whereas Group 2 (n = 72) did not. TGT parameters were measured using an analyzer at pre-, intra-, and early postoperative periods. Activation of the endogenous thrombin potential was observed in patients on prolonged aspirin therapy in the pre- and intraoperative periods, as confirmed by high peak thrombin and increased velocity index. The activation time of the prothrombinase complex and thrombin generation time were greater than the control group. The blood hemostatic potential in patients who did not receive transfusions in the early postoperative period decreased up to the level of the control group in the extended time parameters. Hemostatic potential in plasma in patients on aspirin was preserved. Given the laboratory test results and clinical data, platelet concentrate transfusion is unnecessary for prevention.

• Thrombin generation test
• aspirin therapy
• coronary artery disease
• platelet transfusion

• Coagulopathy
• Coagulopatía
• Politraumatizado
• Polytraumatized
• Thromboelastogram
• Tromboelastograma

• Coagulopathy
• Hemorrhage
• Resuscitation
• Shock
• Thrombelastography
• Transfusion

• Blood Coagulation Disorders/therapy
• Blood Component Transfusion
• Facial Injuries/complications
• Facial Injuries/surgery
• Hemostasis, Surgical/methods
• Humans
• Oral Surgical Procedures
• Resuscitation/methods
• Shock, Hemorrhagic/etiology
• Shock, Hemorrhagic/therapy

• Adult
• Blood Coagulation Disorders/blood
• Blood Coagulation Disorders/diagnosis
• Cardiac Surgical Procedures
• Child
• Erythrocyte Transfusion/adverse effects
• Erythrocyte Transfusion/methods
• Hemorrhage/blood
• Hemorrhage/etiology
• Hemorrhage/mortality
• Hemorrhage/therapy
• Humans
• Liver Transplantation
• Outcome Assessment, Health Care
• Plasma
• Randomized Controlled Trials as Topic
• Thrombelastography/adverse effects
• Thrombelastography/methods

• injury severity score (ISS)
• length of stay (LOS)
• mortality
• reverse shock index (RSI)
• shock index (SI)

• Adult
• Aged
• Blood Pressure
• Female
• Heart Rate
• Hospital Mortality
• Humans
• Injury Severity Score
• Intensive Care Units/statistics & numerical data
• Male
• Middle Aged
• Retrospective Studies
• Taiwan
• Trauma Centers/statistics & numerical data
• Treatment Outcome
• Wounds and Injuries/diagnosis
• Wounds and Injuries/etiology
• Wounds and Injuries/therapy
• Young Adult

Circulatory management is a critical issue in pre-hospital transportation phase of multiple trauma patients. However, the quality of this important care did not receive enough attention.

The aim of this study was to investigate the quality of pre-hospital circulatory management in patients with multiple trauma.

This was a cross-sectional study conducted in 2013. The study population consisted of all patients with multiple trauma who had been transferred by emergency medical services (EMS) to the central trauma department in Kashan Shahid Beheshti medical center, Kashan, Iran. We recruited a convenience sample of 400 patients with multiple trauma. Data were collected using the circulatory assessment questionnaire and controlling hemorrhage (CAQCH) that were designed by the researchers and were described by using frequency tabulations, central tendency measures, and variability indices. The chi-square test was used to analyze the data.

The study sample consisted of 263 males (75.2%); 57.75% had lower levels of education and 28.75% were workers. The most common mechanism of trauma was traffic accident (85.4%). We found that the quality of circulatory management was unfavorable in 61% of the cases. A significant relationship was observed between the quality of circulatory management and type of trauma and staff’s employment status.

The quality of pre-hospital circulatory management provided to patients with multiple trauma was unfavorable. Therefore, establishment of in-service training programs on circulatory management is recommended.

• Circulatory
• Multiple Trauma
• Pre-hospital Care
• Quality

BloodSTOP iX Battle Matrix (BM) and QuikClot Combat Gauze (CG) have both been used to treat traumatic bleeding. The purpose of this study was to examine the efficacy and initial safety of both products in a swine extremity arterial hemorrhage model, which mimics combat injury. Swine (37.13 ± 0.56 kg, N_BM = 11, N_CG = 9) were anesthetized and splenectomized. We then isolated the femoral arteries and performed a 6 mm arteriotomy. After 45 s of free bleeding, either BM or CG was applied. Fluid resuscitation was provided to maintain a mean arterial pressure of 65 mmHg. Animals were observed for three hours or until death. Fluoroscopic angiography and wound stability challenge tests were performed on survivors. Tissue samples were collected for histologic examination. Stable hemostasis was achieved in 11/11 BM and 5/9 CG subjects, with recovery of mean arterial pressure and animal survival for three hours (p < 0.05, Odds Ratio (OR) = 18.82 (0.85–415.3)). Time to stable hemostasis was shorter for the BM-treated group (4.8 ± 2.5 min vs. 58 ± 20.1 min; Median = 2, Interquartile Range (IQR) = 0 min vs. Median = 60, IQR = 120 min; p < 0.05) and experienced longer total stable hemostasis (175.2 ± 2.5 min vs. 92.4 ± 29.9 min; Median = 178, IQR = 0 min vs. Median = 120, IQR = 178 min; p < 0.05). Post-treatment blood loss was lower with BM (9.5 ± 2.4 mL/kg, Median = 10.52, IQR = 13.63 mL/kg) compared to CG (29.9 ± 9.9 mL/kg, Median = 29.38, IQR = 62.44 mL/kg) (p = 0.2875). Standard BM products weighed less compared to CG (6.9 ± 0.03 g vs. 20.2 ± 0.4 g) (p < 0.05) and absorbed less blood (3.4 ± 0.8 g vs. 41.9 ± 12.3 g) (p < 0.05). Fluoroscopic angiography showed recanalization in 5/11 (BM) and 0/5 (CG) surviving animals (p = 0.07, OR = 9.3 (0.41–208.8)). The wound stability challenge test resulted in wound re-bleeding in 1/11 (BM) and 5/5 (CG) surviving animals (p < 0.05, OR = 0.013 (0.00045–0.375)). Histologic evidence indicated no wound site, distal limb or major organ damage in either group. BM is more effective and portable in treating arterial hemorrhage compared to CG. There was no histologic evidence of further damage in either group.

• BloodSTOP Battle Matrix
• QuikClot Combat Gauze
• hemorrhage control
• hemostatic agents
• swine

• Total hip arthroplasty
• fresh frozen plasma
• massive haemorrhage
• massive transfusion
• platelet suspension

• critical care
• hemorrhage
• platelet aggregation inhibitors
• point-of-care systems
• thoracic surgery
• thrombosis

• Anticoagulants/adverse effects
• Anticoagulants/blood
• Anticoagulants/therapeutic use
• Blood Coagulation Disorders/blood
• Blood Coagulation Disorders/diagnosis
• Blood Coagulation Disorders/etiology
• Blood Coagulation Tests/economics
• Blood Coagulation Tests/methods
• Blood Loss, Surgical
• Blood Transfusion
• Cost-Benefit Analysis
• Critical Care/economics
• Critical Care/methods
• Critical Illness
• Disease Management
• Drug Monitoring/methods
• Hemorrhage/blood
• Hemorrhage/chemically induced
• Hemorrhage/etiology
• Hemorrhage/therapy
• Humans
• Platelet Function Tests
• Point-of-Care Systems/economics
• Postoperative Hemorrhage/blood
• Postoperative Hemorrhage/therapy
• Randomized Controlled Trials as Topic
• Thrombelastography/economics
• Wounds and Injuries/blood
• Wounds and Injuries/complications
• Wounds and Injuries/therapy

• Clotting therapy
• Coagulation factor
• Massive transfusion
• Polytrauma
• Standard operating procedure

• Multiple trauma
• blood transfusion
• fluid therapy
• hemorrhage
• mortality
• quality control
• trauma centers

• Postpartum hemorrhage
• fibrinogen
• maternal morbidity
• standard laboratory tests
• tranexamic acid
• transfusion strategy
• viscoelastic hemostatic assays

Haemorrhage is a leading cause of death in paediatric trauma patients. Predefined massive transfusion protocols (MTP) have the potential to significantly reduce mortality by treating haemorrhagic shock and coagulopathy, in adhering to the principles of haemostatic resuscitation with rapid administration of balanced ratios of packed red blood cells (RBC), fresh frozen plasma (FFP) and platelets (PLT).

Because of their substantial physiological reserve, initial vital signs may not be good predictors of early haemorrhage in paediatric patients. Determining the triggers for MTP activation in paediatric trauma patients is challenging, and the optimal blood product ratio that will increase survival in massively bleeding paediatric trauma patients has yet to be determined. To date, only a few small descriptive studies and case reports have investigated the use of predefined MTP in paediatric trauma patients.

MTP with increased FFP or PLT to RBC ratios combined with viscoelastic haemostatic assay (VHA) guided haemostatic resuscitation have not yet been tested in paediatric populations but based on results from adult trauma patients, this therapeutic approach seems promising.

Considering the high prevalence of early coagulopathy in paediatric trauma patients, immediate identification and implementation of VHA-directed treatment of traumatic coagulopathy could ensure faster haemostasis and thereby, potentially, reduce bleeding as well as the total transfusion requirements and further improve outcome in paediatric trauma patients. Prospective randomized trials investigating this therapeutic approach in paediatric trauma patients are highly warranted.

There are many potential influencing factors that affect the duration of intensive care treatment for patients who have survived multiple trauma. Yet the respective factors’ relevance to ICU length of stay (LOS) has been rarely studied. Thus, the aim of the present study was to investigate to what extent specific factors influence ICU LOS in surviving trauma patients.

We retrospectively analyzed a dataset of 30,157 surviving trauma patients from the TraumaRegister DGU® who were older than six years of age and received subsequent intensive care treatment for more than one day, from 2002 to 2011. Univariate analysis and multiple linear regression analysis were used to examine 25 categorical pre- and post-trauma parameters.

Univariate analysis confirmed the impact of all analyzed factors. In subsequent multiple linear regression analyses, coefficients ranged from -1.3 to +8.2 days. The factors that influenced the prolongation of ICU LOS most were renal failure (+8.1 days), sepsis (+7.8 days) and respiratory failure (+4.9 days). Patients spent one additional day in the ICU for every 5 additional points on the Injury Severity Score (regression coefficient +0.2 per point). Furthermore, massive transfusion (+3.3 days), invasive ventilation (+3.1 days), and an initial Glasgow Coma Scale score ≤8 (+3.0 days) had a significant impact on ICU LOS. The coefficient of determination for the model was 44% (R²).

Treatment regimens, as well as secondary effects and complications of trauma and intensive care treatment, prolong ICU LOS more than the mechanism of trauma or pre-trauma patient conditions. Successful prevention of complicated courses of illness, such as sepsis and renal and respiratory failure, could significantly abbreviate the ICU stay in trauma patients. Therefore, the staff’s attention should be focused on preventive strategies.

Coagulopathy is a well-known consequence of trauma and is the most common cause of mortality in the young. However, its cause and management is still controversial. A new concept in the understanding of coagulopathy in trauma is the occurrence of Acute coagulopathy of trauma (ACoT). ACoT is associated with hypo perfusion and tissue trauma as seen in massive injury. The incidence of coagulopathy increases with injury scores and is associated with higher number of ventilator days, higher morbidity and mortality. The process of coagulation is better described by the cell based model with a central role for platelets rather than the older plasma based model. This shift in our understanding supports the theory that ACoT results from the endothelial release of thrombomodulin and activated protein C in the presence of hypoperfusion. This in turn leads on to a hyperfibrinolytic and hypocoagulable state. Viscoelastic hemostatic assays are replacing the older tests like prothrombin time in the assessment of coagulopathy. These tests are accurate, determine the need for transfusion and can be performed at the point of care. Damage control resuscitation includes newer concepts like permissive hypotension, increased use of plasma as a part of massive transfusion protocols and damage control surgery.

• Trauma
• Coagulopathy
• Massive transfusion
• Bleeding
• Thromboelastography

• bleeding
• coagulation tests
• coagulopathy
• damage control resuscitation
• goal-directed therapy
• hemorrhage
• permissive hypotension
• transfusion
• trauma