EMCrit Podcast EMCrit 323 - Trauma Resus Update with Brohi
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May 8, 2022 Karim Brohi, a leading professor in trauma resuscitation, shares his invaluable expertise on modern trauma care. He sheds light on the REFILL trial, which investigates blood component use in resuscitation. The conversation dives into the underused tranexamic acid and challenges like coagulopathy. Brohi emphasizes updating trauma activation criteria post-COVID and highlights the importance of advanced imaging for ischemic limbs. His insights provide a fresh perspective on adapting trauma management to maximize patient outcomes.
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ReFILL Trial Interpretation
- The ReFILL trial's negative result doesn't invalidate current beliefs about bleeding and dilution.
- The trial's results are context-specific and don't align with other trials like PAMPA.
Pre-Hospital Red Cells and In-Hospital Mortality
- Introducing pre-hospital red cells increased early survival but worsened in-hospital mortality initially.
- The hospital needed time to adjust to treating the sicker patients who now survived pre-hospital transport.
Whole Blood Use
- Use whole blood for bleeding patients, especially pre-hospitally, due to logistical ease.
- Whole blood is not a cure-all; stored blood products are adequate but not as effective as fresh whole blood.