The leading cause of avoidable death in trauma patients is hemorrhage.† In contrast to the conventional wisdom on the "golden hour", peak mortality in patients with acute truncal bleeding happens at 30 min.† The median time to bleeding fatality for patients who make it to a hospital is 90–150 minutes after admission.† It is well recognized that a common path to fatal and irreversible shock is through the lethal triad of hypothermia, acidosis, and acute coagulopathy following trauma.
The optimum method for treating traumatic hemorrhage is damage control resuscitation (DCR) with blood components that mimic whole blood in the presence of permissive hypotension, avoiding crystalloid and colloid solutions. The best approach to avoid traumatic hemorrhagic death and prevent trauma induced coagulopathy (TIC) is rapid bleeding control followed by hemorrhage management. This strategy requires plasma transfusion. Dried plasma is a shelf-stable plasma product that is easy to transport and administer.
† Holcomb J. Transport time and preoperating room hemostatic interventions are important. Crit Care Med. 2018;46(3):447–53.
† Alarhayem A, Myers J, Dent D, Liao L, Muir M, Mueller D, et al. Time is the enemy: mortality in trauma patients with hemorrhage from torso injury occurs long before the “golden hour”. Am J Surg. 2016;212(6):1101–5.
† Holcomb J, del Junco D, Fox E, Wade C, Cohen M, Schreiber M, et al. The prospective, observational, multicenter, major trauma transfusion [PROMMTT] study. JAMA Surg. 2013;148(2):127.
