Intra-operative correction of acidosis, coagulopathy and hypothermia in combat casualties with severe haemorrhagic shock

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Abstract

We assessed acidosis, coagulopathy and hypothermia, before and after surgery in 51 combat troops operated on for severe blast injury. Patients were transfused a median (IQR [range]) of 27 (17–38 [5–84]) units of red cell concentrate, 27 (16–38 [4–83]) units of plasma, 2.0 (0.5–3.5 [0–13.0]) units of cryoprecipitate and 4 (2–6 [0–17]) pools of platelets. The pH, base excess, prothrombin time and temperature increased: from 7.19 (7.10–7.29 [6.50–7.49]) to 7.45 (7.40–7.51 [7.15–7.62]); from −9.0 (−13.5 to −4.5 [−28 to –2]) mmol.l−1 to 4.5 (1.0–8.0 [−7 to +11]) mmol.l−1; from 18 (15–21 [9–24]) s to 14 (11–18 [9–21]) s; and from 36.1 (35.1–37.1 [33.0–38.1]) °C to 37.4 (37.0–37.9 [36.0–38.0]) °C, respectively. Contemporary intra-operative resuscitation strategies can normalise the physiological derangements caused by haemorrhagic shock.

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