Comparing hemostatic resuscitation management of intraoperative massive bleeding with traumatic massive bleeding: a computer simulationopen access
- Authors
- Lee, Young Sun; Kim Kyu Nam; Lee Min Kyu; Sun Jung Eun; Lim, Hyun Jin; Jun, Jong Hun
- Issue Date
- Oct-2020
- Publisher
- 대한마취통증의학회
- Keywords
- Blood coagulation disorder; Blood component transfusion; Computer simulation; Hemorrhage.
- Citation
- Anesthesia and Pain Medicine, v.15, no.4, pp.459 - 465
- Indexed
- KCI
- Journal Title
- Anesthesia and Pain Medicine
- Volume
- 15
- Number
- 4
- Start Page
- 459
- End Page
- 465
- URI
- https://scholarworks.bwise.kr/hanyang/handle/2021.sw.hanyang/145052
- DOI
- 10.17085/apm.20042
- ISSN
- 1975-5171
- Abstract
- Background
Appropriate blood component transfusion might differ between intraoperative massive bleeding and traumatic massive bleeding in the emergency department because trauma patients initially bleed undiluted blood and replacement typically lags behind blood loss. We compared these two blood loss scenarios, intraoperative and traumatic, using a computer simulation.
Methods
We modified the multi-compartment dynamic model developed by Hirshberg and implemented it using STELLA 9.0. In this model, blood pressure changes as blood volume fluctuates as bleeding rate and transcapillary refill rate are controlled by blood pressure. Using this simulation, we compared the intraoperative bleeding scenario with the traumatic bleeding scenario. In both scenarios, patients started to bleed at a rate of 50 ml/min. In the intraoperative bleeding scenario, fluid was administered to maintain isovolemic status; however, in the traumatic bleeding scenario, no fluid was supplied for up to 30 min and no blood was supplied for up to 50 min. Each unit of packed red blood cells (PRBC) was given when the hematocrit decreased to 27%, fresh frozen plasma (FFP) was transfused when plasma was diluted to 30%, and platelet concentrate (PC) was transfused when platelet count became 50,000/ml.
Results
In both scenarios, the appropriate ratio of PRBC:FFP was 1:0.47 before PC transfusion, and the ratio of PRBC:FFP:platelets was 1:0.35:0.39 after initiation of PC transfusion.
Conclusion
The ratio of transfused blood component did not differ between the intraoperative bleeding and traumatic bleeding scenarios.
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