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Comparing hemostatic resuscitation management of intraoperative massive bleeding with traumatic massive bleeding: a computer simulation

Anesthesia and Pain Medicine 2020년 15권 4호 p.459 ~ 465
이영선, 김규남, 이민규, 선정은, 임현진, 전종헌,
소속 상세정보
이영선 ( Lee Young-Sun ) - Hanyang University Graduate School Department of Medicine
김규남 ( Kim Kyu-Nam ) - Hanyang University College of Medicine Department of Anesthesiology and Pain Medicine
이민규 ( Lee Min-Kyu ) - Hanyang University College of Medicine Department of Anesthesiology and Pain Medicine
선정은 ( Sun Jung-Eun ) - Hanyang University College of Medicine Department of Anesthesiology and Pain Medicine
임현진 ( Lim Hyun-Jin ) - Hanyang University College of Medicine Department of Anesthesiology and Pain Medicine
전종헌 ( Jun Jong-Hun ) - Hanyang University College of Medicine Department of Anesthesiology and Pain Medicine

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.

키워드

Blood coagulation disorder; Blood component transfusion; Computer simulation; Hemorrhage

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