Whole blood versus balanced resuscitation in massive hemorrhage: Six of one or half dozen of the other?

Background: Whole blood (WB) resuscitation is increasingly used at trauma centers. Prior studies investigating outcomes in WB versus component-only (CO) resuscitation have been limited by small cohorts, low volumes of WB resuscitation, and unbalanced CO resuscitation. This study aimed to address these limitations using data from a high-volume Level I trauma center, which adopted a WB-first resuscitation paradigm in 2018.

Comparison of bleeding and thrombotic outcomes in veno-venous extracorporeal membrane oxygenation: Heparin versus bivalirudin.

Objectives: We aimed to evaluate thrombotic and hemorrhagic complications with heparin versus bivalirudin use in veno-venous extracorporeal membrane oxygenation (V-V ECMO).

Methods: We performed a retrospective cohort study of adult patients placed on V-V ECMO with intravenous anticoagulation with either heparin or bivalirudin. Time to thrombotic event and major bleed were analyzed in addition to related outcomes.

The impact of low-dose aspirin in the Brain Injury Guidelines on outcomes in traumatic brain injury: A retrospective cohort study.

Background: Current Brain Injury Guidelines (BIG) characterize patients with intracranial hemorrhage taking antiplatelet or anticoagulant agents as BIG 3 (the most severe category) regardless of trauma severity. This study assessed the risk of in-hospital mortality or need for neurosurgery in patients taking low-dose aspirin who otherwise would be classified as BIG 1.

Methods: This was a retrospective study at an academic level 1 trauma center.

Incidence of traumatic intracranial hemorrhage expansion after stable repeat head imaging: A retrospective cohort study.

Introduction: Patients with traumatic intracranial hemorrhage (tICH) often require intensive care unit (ICU) admission until bleeding stability is demonstrated through interval head computed tomography (HCT). The brain injury guidelines (BIG) suggest a minimum 24-h ICU admission for severe patients (BIG 3) regardless of repeat CT stability. We sought to evaluate the rate of tICH expansion after an initial stable interval scan was obtained.

Thromboelastography with platelet mapping: Limited predictive ability in detecting preinjury antiplatelet agent use.

Background: Preinjury antiplatelet agent (APA) use in trauma patients can increase traumatic hemorrhage and worsen outcomes. Thromboelastography with platelet mapping (TEGPM) has characterized platelet function via arachidonic acid (AA) and adenosine diphosphate (ADP) inhibition in nontrauma settings, but limited data exist in the acute trauma population.

Methods: A prospective observational study of adult trauma patients with suspected preinjury APA use who received TEGPM testing from 2017 to 2020 was performed.