Comparing hemostatic resuscitation management of intraoperative massive bleeding with traumatic massive bleeding: a computer simulation
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 los...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Korean Society of Anesthesiologists
2020-10-01
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| Series: | Anesthesia and Pain Medicine |
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| Online Access: | http://www.anesth-pain-med.org/upload/pdf/apm-20042.pdf |
| _version_ | 1797825451336400896 |
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| author | Young Sun Lee Kyu Nam Kim Min Kyu Lee Jung Eun Sun Hyun Jin Lim Jong Hun Jun |
| author_facet | Young Sun Lee Kyu Nam Kim Min Kyu Lee Jung Eun Sun Hyun Jin Lim Jong Hun Jun |
| author_sort | Young Sun Lee |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-13T10:54:13Z |
| format | Article |
| id | doaj.art-49bb0155ae5e494fab3835e7d60d9aaf |
| institution | Directory Open Access Journal |
| issn | 1975-5171 2383-7977 |
| language | English |
| last_indexed | 2024-03-13T10:54:13Z |
| publishDate | 2020-10-01 |
| publisher | Korean Society of Anesthesiologists |
| record_format | Article |
| series | Anesthesia and Pain Medicine |
| spelling | doaj.art-49bb0155ae5e494fab3835e7d60d9aaf2023-05-17T05:41:40ZengKorean Society of AnesthesiologistsAnesthesia and Pain Medicine1975-51712383-79772020-10-0115445946510.17085/apm.200421042Comparing hemostatic resuscitation management of intraoperative massive bleeding with traumatic massive bleeding: a computer simulationYoung Sun Lee0Kyu Nam Kim1Min Kyu Lee2Jung Eun Sun3Hyun Jin Lim4Jong Hun Jun5 Department of Medicine, Hanyang University Graduate School, Seoul, Korea Department of Anesthesiology and Pain Medicine, Hanyang University College of Medicine, Seoul, Korea Department of Anesthesiology and Pain Medicine, Hanyang University College of Medicine, Seoul, Korea Department of Anesthesiology and Pain Medicine, Hanyang University College of Medicine, Seoul, Korea Department of Anesthesiology and Pain Medicine, Hanyang University College of Medicine, Seoul, Korea Department of Anesthesiology and Pain Medicine, Hanyang University College of Medicine, Seoul, KoreaBackground 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.http://www.anesth-pain-med.org/upload/pdf/apm-20042.pdfblood coagulation disorderblood component transfusioncomputer simulationhemorrhage |
| spellingShingle | Young Sun Lee Kyu Nam Kim Min Kyu Lee Jung Eun Sun Hyun Jin Lim Jong Hun Jun Comparing hemostatic resuscitation management of intraoperative massive bleeding with traumatic massive bleeding: a computer simulation Anesthesia and Pain Medicine blood coagulation disorder blood component transfusion computer simulation hemorrhage |
| title | Comparing hemostatic resuscitation management of intraoperative massive bleeding with traumatic massive bleeding: a computer simulation |
| title_full | Comparing hemostatic resuscitation management of intraoperative massive bleeding with traumatic massive bleeding: a computer simulation |
| title_fullStr | Comparing hemostatic resuscitation management of intraoperative massive bleeding with traumatic massive bleeding: a computer simulation |
| title_full_unstemmed | Comparing hemostatic resuscitation management of intraoperative massive bleeding with traumatic massive bleeding: a computer simulation |
| title_short | Comparing hemostatic resuscitation management of intraoperative massive bleeding with traumatic massive bleeding: a computer simulation |
| title_sort | comparing hemostatic resuscitation management of intraoperative massive bleeding with traumatic massive bleeding a computer simulation |
| topic | blood coagulation disorder blood component transfusion computer simulation hemorrhage |
| url | http://www.anesth-pain-med.org/upload/pdf/apm-20042.pdf |
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