Massive Transfusion Adjuncts for the Traumatically Injured Patient

Purpose of Review Early resuscitation with blood products for traumatically injured patients in hemorrhagic shock represents the current standard of care. Evolving literature has demonstrated potential benefits with supplementation and adjunctive therapies during massive transfusion. This review aims to summarize the recently studied adjuncts aimed to augment massive transfusion protocols. Recent Findings Recent evidence supports the use of various pharmacologic adjuncts to help support trauma patients during ongoing resuscitation. Calcium supplementation has been shown to reduce mortality among patients with severe hypocalcemia secondary to citrate chelation from large volume transfusions. Whole blood use during resuscitation has been proven to be a safe and effective strategy and remains an extremely active area of ongoing research. Prevention of fibrinolysis via the early administration of tranexamic acid has demonstrated mortality benefit, albeit mixed data persists regarding its potential thrombogenic nature. Vasopressor therapy may have a role in hemorrhagic shock as vasopressin has been associated with decreased blood product utilization in select populations; however, further studies are necessary to evaluate for survival benefit. Prothrombin complex concentrate as an addition to whole blood therapy can decrease total transfusion requirement, and large trials are ongoing to determine other clinical implications. Summary Blood product transfusion for traumatically injured patients represents a critical component of damage control resuscitation. Calcium supplementation, whole blood, tranexamic acid, vasopressor therapy, and prothrombin complex concentrate represent pharmacologic therapies with potential to augment transfusion needs. Future studies are necessary to solidify their definitive associations with survival impact.