List Archives

Fri Aug 10 15:44:00 BST 2007

Brian,

1/Crystalloids stay intravascular only perhaps 30 - 45 minutes - it is an obviously temporizing measure.
In somebody who lost a lot of blood, it makes sense to temporize if you don't have blood product - but not once you actually have them. 
Same with 1:1 - why give RBCs only when you're also losing plasma and platelets, right ?

2/ Crystalloids - again, because they don't stay intravascular - lead to swelling in all organs. It makes the most sense in a trunk with concomitant TBI (traumatic brain injury) - most people will understand you shouldn't give crystalloids as you worsen CNS edema. Why create dilutional coagulopathy if you don't have to ? Crystalloids also lead to hypercoagulablility, immune responses etc.

2/ Persuade the Blood Bank and once you institute a Massive Transfusion Protocol you'll be getting the products in the OR automatically, without having to order them.
That will make it will more practical for the anesthesiologists to give them as they are already there. 
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As to the supporting data: things change as fashions do. Look how off-pump CABG went without studies proving it is better - sometimes you just do things the other way and study them as you go.
The answer is there are no great data to prove it is better the other way (check PT/PTTand plts prior to ordering FFP/plts)- so you can do it this way (1:1), and study it - right ?

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Mike, 

why are you singling out Ringer's Lactate, if you have to use crystalloids it is the one to use, as NS in larger volumes causes hyperchloremic metabolic acidosis, hypernatraemia and hyperosmolallity.
It is a common mistake to give large volumes of NS just because it is compatible with blood.
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Ivan Hronek MDChief, Critical Care & Trauma AnesthesiaSFMC Gas, Inc.Lynwood, CA

> Date: Fri, 10 Aug 2007 08:53:11 -0400> From: Brian.Green at oakwood.org> To: trauma-list at trauma.org> Subject: RE: Implementing 1 to1 pRBCs to FFP for Resuscitation> > The trouble i'm running into is the lack of data to support this. I agree it is what we need to do, but it is anesthesia that is resisting. How did you show them the light?> > > > -----Original Message-----> From: trauma-list-bounces at trauma.org> [mailto:trauma-list-bounces at trauma.org]On Behalf Of Sise, Mike MD> Sent: Friday, August 10, 2007 8:46 AM> To: trauma-list at trauma.org> Subject: Implementing 1 to1 pRBCs to FFP for Resuscitation> > > To my colleagues around the Trauma world,> > We've implemented a combination of permissive hypotension, limiting crystalloids (No Ringers!), and 1 to 1 packed cells to FFP transfusion ratio for life threatening hemorrhage with remarkable results. It takes time to get the Blood Bank, ICU nurses and, most importantly, the Anesthesiologists onboard. > > I would be very interested in lessons learned from other centers who have adopted this approach and in any doubts about this approach some of you may have. > > Your thoughts?> > Mike Sise> San Diego> > "Scripps Information Security" > ------------------------------------------------------------------------------> This e-mail and any files transmitted with it may contain privileged and confidential information and are intended solely for the use of the individual or entity to which they are addressed. If you are not the intended recipient or the person responsible for delivering the e-mail to the intended recipient, you are hereby notified that any dissemination or copying of this e-mail or any of its attachment(s) is strictly prohibited. If you have received this e-mail in error, please immediately notify the sending individual or entity by e-mail and permanently delete the original e-mail and attachment(s) from your computer system. Thank you for your cooperation.> > > ==============================================================================> --> trauma-list : TRAUMA.ORG> To change your settings or unsubscribe visit:> http://www.trauma.org/index.php?/community/> > --> trauma-list : TRAUMA.ORG> To change your settings or unsubscribe visit:> http://www.trauma.org/index.php?/community/

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Implementing 1 to1 pRBCs to FFP for Resuscitation