Published in:
01-05-2019 | Editorial
Why are bleeding trauma patients still dying?
Published in: Intensive Care Medicine | Issue 5/2019
Login to get accessExcerpt
Haemorrhage after injury contributes to over half of the five million traumatic deaths that occur every year. Since acute traumatic coagulopathy was described 15 years ago, trauma resuscitation has transformed. Now, rapid control of bleeding and maintenance of the blood’s haemostatic competence are prioritized—a paradigm known as ‘damage control’ or ‘haemostatic’ resuscitation—with dramatic reductions in pre-hospital and in-hospital mortality [1‐3]. Yet for the most critically injured patients requiring emergent surgery, overall mortality has changed little, and remains close to 50% [4, 5]. Despite improved haemorrhage control, many patients still die, and often not from exsanguination but later in their clinical course, through mechanisms which are not yet fully understood (Fig. 1).
Fig. 1
Time distribution of mortality of patients activating a major haemorrhage protocol and receiving at least one unit of red blood cell transfusion. Overall mortality reduced 25% from 2009 to 2015. A drop in pre-hospital mortality resulted in a 50% higher death rate immediately post admission. Improvements in management of coagulopathy dramatically reduced mortality rates between 3 h and 24 h but was associated with a 44% increase in later deaths.
× ![]()
…