Journal of Trauma and Injury

  • 제33권1호
  • /
  • Pages.1-12
  • /
  • 2020
  • /
  • 2799-4317(pISSN)
  • /
  • 2287-1683(eISSN)
대한외상학회 (The Korean Society of Traumatology)
권호 표지
DOI QR코드

DOI QR Code

Clinical Practice Guideline for the Treatment of Traumatic Shock Patients from the Korean Society of Traumatology

  • Jung, Pil Young (Department of Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine) ;
  • Yu, Byungchul (Department of Traumatology, Gachon University College of Medicine, Gachon University Gil Medical Center) ;
  • Park, Chan-Yong (Department of Trauma Surgery, Wonkwang University Hospital) ;
  • Chang, Sung Wook (Department of Thoracic and Cardiovascular Surgery, Trauma Center, Dankook University Hospital) ;
  • Kim, O Hyun (Department of Emergency Medicine, Wonju College of Medicine, Yonsei University) ;
  • Kim, Maru (Department of Trauma Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Kwon, Junsik (Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine) ;
  • Lee, Gil Jae (Department of Traumatology, Gachon University College of Medicine, Gachon University Gil Medical Center) ;
  • Korean Society of Traumatology (KST) Clinical Research Group (Korean Society of Traumatology (KST))
  • 투고 : 2020.03.25
  • 심사 : 2020.03.25
  • 발행 : 2020.03.30
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Purpose: Despite recent developments in the management of trauma patients in South Korea, a standardized system and guideline for trauma treatment are absent. Methods: Five guidelines were assessed using the Appraisal of Guidelines for Research and Evaluation II instrument. Results: Restrictive volume replacement must be used for patients experiencing shock from trauma until hemostasis is achieved (1B). The target systolic pressure for fluid resuscitation should be 80-90 mmHg in hypovolemic shock patients (1C). For patients with head trauma, the target pressure for fluid resuscitation should be 100-110 mmHg (2C). Isotonic crystalloid fluid is recommended for initially treating traumatic hypovolemic shock patients (1A). Hypothermia should be prevented in patients with severe trauma, and if hypothermia occurs, the body temperature should be increased without delay (1B). Acidemia must be corrected with an appropriate means of treatment for hypovolemic trauma patients (1B). When a large amount of transfusion is required for trauma patients in hypovolemic shock, a massive transfusion protocol (MTP) should be used (1B). The decision to implement MTP should be made based on hemodynamic status and initial responses to fluid resuscitation, not only the patient's initial condition (1B). The ratio of plasma to red blood cell concentration should be at least 1:2 for trauma patients requiring massive transfusion (1B). When a trauma patient is in life-threatening hypovolemic shock, vasopressors can be administered in addition to fluids and blood products (1B). Early administration of tranexamic acid is recommended in trauma patients who are actively bleeding or at high risk of hemorrhage (1B). For hypovolemic patients with coagulopathy non-responsive to primary therapy, the use of fibrinogen concentrate, cryoprecipitate, or recombinant factor VIIa can be considered (2C). Conclusions: This research presents Korea's first clinical practice guideline for patients with traumatic shock. This guideline will be revised with updated research every 5 years.

키워드

참고문헌

  1. Jung KY, Kim JS, Kim Y. Problems in trauma care and preventable deaths. J Korean Soc Emerg Med 2001;12:45-56.
  2. Cothren CC, Moore EE, Hedegaard HB, Meng K. Epidemiology of urban trauma deaths: a comprehensive reassessment 10 years later. World J Surg 2007;31:1507-11. https://doi.org/10.1007/s00268-007-9087-2
  3. Davenport RA, Guerreiro M, Frith D, Rourke C, Platton S, Cohen M, et al. Activated protein C drives the hyperfibrinolysis of acute traumatic coagulopathy. Anesthesiology 2017;126:115-27. https://doi.org/10.1097/ALN.0000000000001428
  4. Brohi K, Singh J, Heron M, Coats T. Acute traumatic coagulopathy. J Trauma 2003;54:1127-30. https://doi.org/10.1097/01.TA.0000069184.82147.06
  5. Khan S, Davenport R, Raza I, Glasgow S, De'Ath HD, Johansson PI, et al. Damage control resuscitation using blood component therapy in standard doses has a limited effect on coagulopathy during trauma hemorrhage. Intensive Care Med 2015;41:239-47. https://doi.org/10.1007/s00134-014-3584-1
  6. MacLeod JB, Lynn M, McKenney MG, Cohn SM, Murtha M. Early coagulopathy predicts mortality in trauma. J Trauma 2003;55:39-44. https://doi.org/10.1097/01.TA.0000075338.21177.EF
  7. Maegele M, Lefering R, Yucel N, Tjardes T, Rixen D, Paffrath T, et al. Early coagulopathy in multiple injury: an analysis from the German Trauma Registry on 8724 patients. Injury 2007;38:298-304. https://doi.org/10.1016/j.injury.2006.10.003
  8. Maegele M, Schochl H, Cohen MJ. An update on the coagulopathy of trauma. Shock 2014;41(Suppl 1):21-5. https://doi.org/10.1097/SHK.0000000000000088
  9. Martin M, Oh J, Currier H, Tai N, Beekley A, Eckert M, et al. An analysis of in-hospital deaths at a modern combat support hospital. J Trauma 2009;66(4 Suppl):S51-60; discussion S60-1.
  10. Smith W, Williams A, Agudelo J, Shannon M, Morgan S, Stahel P, et al. Early predictors of mortality in hemodynamically unstable pelvis fractures. J Orthop Trauma 2007;21:31-7. https://doi.org/10.1097/BOT.0b013e31802ea951
  11. Bickell WH, Wall MJ Jr, Pepe PE, Martin RR, Ginger VF, Allen MK, et al. Immediate versus delayed fluid resuscitation for hypotensive patients with penetrating torso injuries. N Engl J Med 1994;331:1105-9. https://doi.org/10.1056/NEJM199410273311701
  12. Dutton RP, Mackenzie CF, Scalea TM. Hypotensive resuscitation during active hemorrhage: impact on in-hospital mortality. J Trauma 2002;52:1141-6. https://doi.org/10.1097/00005373-200206000-00020
  13. Kwan I, Bunn F, Roberts I; WHO Pre-Hospital Trauma Care Steering Committee. Timing and volume of fluid administration for patients with bleeding. Cochrane Database Syst Rev 2003;3:CD002245.
  14. Neal MD, Hoffman MK, Cuschieri J, Minei JP, Maier RV, Harbrecht BG, et al. Crystalloid to packed red blood cell transfusion ratio in the massively transfused patient: when a little goes a long way. J Trauma Acute Care Surg 2012;72:892-8. https://doi.org/10.1097/ta.0b013e31823d84a7
  15. Young JB, Utter GH, Schermer CR, Galante JM, Phan HH, Yang Y, et al. Saline versus Plasma-Lyte A in initial resuscitation of trauma patients: a randomized trial. Ann Surg 2014;259:255-62. https://doi.org/10.1097/SLA.0b013e318295feba
  16. Perel P, Roberts I, Ker K. Colloids versus crystalloids for fluid resuscitation in critically ill patients. Cochrane Database Syst Rev 2013;(2):CD000567.
  17. Kutcher ME, Howard BM, Sperry JL, Hubbard AE, Decker AL, Cuschieri J, et al. Evolving beyond the vicious triad: differential mediation of traumatic coagulopathy by injury, shock, and resuscitation. J Trauma Acute Care Surg 2015;78:516-23. https://doi.org/10.1097/TA.0000000000000545
  18. Watts DD, Trask A, Soeken K, Perdue P, Dols S, Kaufmann C. Hypothermic coagulopathy in trauma: effect of varying levels of hypothermia on enzyme speed, platelet function, and fibrinolytic activity. J Trauma 1998;44:846-54. https://doi.org/10.1097/00005373-199805000-00017
  19. Bernabei AF, Levison MA, Bender JS. The effects of hypothermia and injury severity on blood loss during trauma laparotomy. J Trauma 1992;33:835-9. https://doi.org/10.1097/00005373-199212000-00007
  20. Rubiano AM, Sanchez AI, Estebanez G, Peitzman A, Sperry J, Puyana JC. The effect of admission spontaneous hypothermia on patients with severe traumatic brain injury. Injury 2013;44:1219-25. https://doi.org/10.1016/j.injury.2012.11.026
  21. Eddy VA, Morris JA Jr, Cullinane DC. Hypothermia, coagulopathy, and acidosis. Surg Clin North Am 2000;80:845-54. https://doi.org/10.1016/S0039-6109(05)70099-2
  22. Barthel ER, Pierce JR. Steady-state and time-dependent thermodynamic modeling of the effect of intravenous infusion of warm and cold fluids. J Trauma Acute Care Surg 2012;72:1590-600. https://doi.org/10.1097/ta.0b013e31824a7943
  23. Lier H, Krep H, Schroeder S, Stuber F. Preconditions of hemostasis in trauma: a review. The influence of acidosis, hypocalcemia, anemia, and hypothermia on functional hemostasis in trauma. J Trauma 2008;65:951-60. https://doi.org/10.1097/TA.0b013e318187e15b
  24. Beekley AC. Damage control resuscitation: a sensible approach to the exsanguinating surgical patient. Crit Care Med 2008;36(7 Suppl):S267-74. https://doi.org/10.1097/CCM.0b013e31817da7dc
  25. Meng ZH, Wolberg AS, Monroe DM 3rd, Hoffman M. The effect of temperature and pH on the activity of factor VIIa: implications for the efficacy of high-dose factor VIIa in hypothermic and acidotic patients. J Trauma 2003;55:886-91. https://doi.org/10.1097/01.TA.0000066184.20808.A5
  26. Yucel N, Lefering R, Maegele M, Vorweg M, Tjardes T, Ruchholtz S, et al. Trauma associated severe hemorrhage (TASH)-score: probability of mass transfusion as surrogate for life threatening hemorrhage after multiple trauma. J Trauma 2006;60:1228-36; discussion 1236-7. https://doi.org/10.1097/01.ta.0000220386.84012.bf
  27. Brohi K, Cohen MJ, Davenport RA. Acute coagulopathy of trauma: mechanism, identification and effect. Curr Opin Crit Care 2007;13:680-5. https://doi.org/10.1097/MCC.0b013e3282f1e78f
  28. Spahn DR, Rossaint R. Coagulopathy and blood component transfusion in trauma. Br J Anaesth 2005;95:130-9. https://doi.org/10.1093/bja/aei169
  29. Martini WZ. Coagulopathy by hypothermia and acidosis: mechanisms of thrombin generation and fibrinogen availability. J Trauma 2009;67:202-8; discussion 208-9.
  30. Brockamp T, Nienaber U, Mutschler M, Wafaisade A, Peiniger S, Lefering R, et al. Predicting on-going hemorrhage and transfusion requirement after severe trauma: a validation of six scoring systems and algorithms on the TraumaRegister DGU. Critical care 2012;16:R129. https://doi.org/10.1186/cc11432
  31. Cotton BA, Gunter OL, Isbell J, Au BK, Robertson AM, Morris JA Jr, et al. Damage control hematology: the impact of a trauma exsanguination protocol on survival and blood product utilization. J Trauma 2008;64:1177-82; discussion 1182-3. https://doi.org/10.1097/TA.0b013e31816c5c80
  32. Cotton BA, Dossett LA, Haut ER, Shafi S, Nunez TC, Au BK, et al. Multicenter validation of a simplified score to predict massive transfusion in trauma. J Trauma 2010;69 Suppl 1:S33-9.
  33. Krumrei NJ, Park MS, Cotton BA, Zielinski MD. Comparison of massive blood transfusion predictive models in the rural setting. J Trauma Acute Care Surg 2012;72:211-5. https://doi.org/10.1097/TA.0b013e318240507b
  34. Mitra B, Rainer TH, Cameron PA. Predicting massive blood transfusion using clinical scores post-trauma. Vox Sang 2012;102:324-30. https://doi.org/10.1111/j.1423-0410.2011.01564.x
  35. Mitra B, Mori A, Cameron PA, Fitzgerald M, Paul E, Street A. Fresh frozen plasma (FFP) use during massive blood transfusion in trauma resuscitation. Injury 2010;41:35-9. https://doi.org/10.1016/j.injury.2009.09.029
  36. McLaughlin DF, Niles SE, Salinas J, Perkins JG, Cox ED, Wade CE, et al. A predictive model for massive transfusion in combat casualty patients. J Trauma 2008;64(2 Suppl):S57-63; discussion S63.
  37. Vandromme MJ, Griffin RL, McGwin G Jr, Weinberg JA, Rue LW 3rd, Kerby JD. Prospective identification of patients at risk for massive transfusion: an imprecise endeavor. Am Surg 2011;77:155-61. https://doi.org/10.1177/000313481107700212
  38. Dente CJ, Shaz BH, Nicholas JM, Harris RS, Wyrzykowski AD, Patel S, et al. Improvements in early mortality and coagulopathy are sustained better in patients with blunt trauma after institution of a massive transfusion protocol in a civilian level I trauma center. J Trauma 2009;66:1616-24. https://doi.org/10.1097/TA.0b013e3181a59ad5
  39. Holcomb JB, Tilley BC, Baraniuk S, Fox EE, Wade CE, Podbielski JM, et al. Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma: the PROPPR randomized clinical trial. JAMA 2015;313:471-82. https://doi.org/10.1001/jama.2015.12
  40. Ho AM-H, Dion PW, Yeung JH, Holcomb JB, Critchley LA, Ng CS, et al. Prevalence of survivor bias in observational studies on fresh frozen plasma:erythrocyte ratios in trauma requiring massive transfusion. Anesthesiology 2012;116:716-28. https://doi.org/10.1097/ALN.0b013e318245c47b
  41. Holcomb JB, Jenkins D, Rhee P, Johannigman J, Mahoney P, Mehta S, et al. Damage control resuscitation: directly addressing the early coagulopathy of trauma. J Trauma 2007;62:307-10. https://doi.org/10.1097/TA.0b013e3180324124
  42. Kelly JM, Callum JL, Rizoli SB. 1:1:1 - warranted or wasteful? Even where appropriate, high ratio transfusion protocols are costly: early transition to individualized care benefits patients and transfusion services. Expert Rev Hematol 2013;6:631-3. https://doi.org/10.1586/17474086.2013.859520
  43. Ketchum L, Hess JR, Hiippala S. Indications for early fresh frozen plasma, cryoprecipitate, and platelet transfusion in trauma. J Trauma 2006;60(6 Suppl):S51-8.
  44. Snyder CW, Weinberg JA, McGwin G Jr, Melton SM, George RL, Reiff DA, et al. The relationship of blood product ratio to mortality: survival benefit or survival bias? J Trauma 2009;66:358- 62; discussion 362-4. https://doi.org/10.1097/TA.0b013e318196c3ac
  45. Gelman S, Mushlin PS. Catecholamine-induced changes in the splanchnic circulation affecting systemic hemodynamics. Anesthesiology 2004;100:434-9. https://doi.org/10.1097/00000542-200402000-00036
  46. Poloujadoff MP, Borron SW, Amathieu R, Favret F, Camara MS, Lapostolle F, et al. Improved survival after resuscitation with norepinephrine in a murine model of uncontrolled hemorrhagic shock. Anesthesiology 2007;107:591-6. https://doi.org/10.1097/01.anes.0000281926.54940.6a
  47. Herrois A, Hamada SR, Duranteau J. Fluid resuscitation and vasopressors in severe trauma patients. Curr Opin Crit Care 2014;20:632-7. https://doi.org/10.1097/MCC.0000000000000159
  48. Cohn SM, McCarthy J, Stewart RM, Jonas RB, Dent DL, Michalek JE. Impact of low-dose vasopressin on trauma outcome: prospective randomized study. World J Surg 2011;35:430-9. https://doi.org/10.1007/s00268-010-0875-8
  49. Ker K, Roberts I, Shakur H, Coats TJ. Antifibrinolytic drugs for acute traumatic injury. Cochrane Database Syst Rev 2015;(5):CD004896.
  50. CRASH-2 trial collaborators; Shakur H, Roberts I, Bautista R, Caballero J, Coats T, Dewan Y, et al. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet 2010;376:23-32. https://doi.org/10.1016/S0140-6736(10)60835-5
  51. CRASH-2 collaborators; Roberts I, Shakur H, Afolabi A, Brohi K, Coats T, Dewan Y, et al. The importance of early treatment with tranexamic acid in bleeding trauma patients: an exploratory analysis of the CRASH-2 randomised controlled trial. Lancet 2011;377:1096-101, 1101.e1-2. https://doi.org/10.1016/S0140-6736(11)60278-X
  52. Yutthakasemsunt S, Kittiwatanagul W, Piyavechvirat P, Thinkamrop B, Phuenpathom N, Lumbiganon P. Tranexamic acid for patients with traumatic brain injury: a randomized, double-blinded, placebo-controlled trial. BMC Emerg Med 2013;13:20. https://doi.org/10.1186/1471-227X-13-20
  53. Bombeli T, Spahn DR. Updates in perioperative coagulation: physiology and management of thromboembolism and haemorrhage. Br J Anaesth 2004;93:275-87. https://doi.org/10.1093/bja/aeh174
  54. Furie B, Furie BC. Mechanisms of thrombus formation. N Engl J Med 2008;359:938-49. https://doi.org/10.1056/NEJMra0801082
  55. Shaz BH, Dente CJ, Nicholas J, MacLeod JB, Young AN, Easley K, et al. Increased number of coagulation products in relationship to red blood cell products transfused improves mortality in trauma patients. Transfusion 2010;50:493-500. https://doi.org/10.1111/j.1537-2995.2009.02414.x
  56. Sarode R, Milling TJ Jr, Refaai MA, Mangione A, Schneider A, Durn BL, et al. Efficacy and safety of a 4-factor prothrombin complex concentrate in patients on vitamin K antagonists presenting with major bleeding: a randomized, plasma-controlled, phase IIIb study. Circulation 2013;128:1234-43. https://doi.org/10.1161/CIRCULATIONAHA.113.002283
  57. Hoffman M. A cell-based model of coagulation and the role of factor VIIa. Blood Rev 2003;17 Suppl 1:S1-5. https://doi.org/10.1016/S0268-960X(03)90000-2
  58. Hoffman M, Monroe DM 3rd. A cell-based model of hemostasis. Thromb Haemost 2001;85:958-65. https://doi.org/10.1055/s-0037-1615947
  59. Luna GK, Maier RV, Pavlin EG, Anardi D, Copass MK, Oreskovich MR. Incidence and effect of hypothermia in seriously injured patients. J Trauma 1987;27:1014-8. https://doi.org/10.1097/00005373-198709000-00010
  60. DeLoughery TG. Coagulation defects in trauma patients: etiology, recognition, and therapy. Crit Care Clin 2004;20:13-24. https://doi.org/10.1016/S0749-0704(03)00089-7
  61. Boffard KD, Riou B, Warren B, Choong PI, Rizoli S, Rossaint R, et al. Recombinant factor VIIa as adjunctive therapy for bleeding control in severely injured trauma patients: two parallel randomized, placebo-controlled, double-blind clinical trials. J Trauma 2005;59:8-15; discussion 15-8. https://doi.org/10.1097/01.TA.0000171453.37949.B7