Reconstituted whole blood plus fibrinogen for massive transfusion in trauma
Bibliographic record
Abstract
The data by Ponschab et al. 1 show that reconstituted whole blood using equal numbers of units of packed red blood cells, fresh frozen plasma (FFP) and platelets contains borderline concentrations of fibrinogen. Nonetheless, in severe and continuous haemorrhage, this 1:1:1 mixture currently represents the least unbalanced solution for sustained resuscitation, both from the volume and contents perspectives. An impetus behind Ponschab et al.'s study is the ongoing controversy on how best to give plasma and platelets in trauma resuscitation requiring massive transfusion 2. On one side are clinicians who, backed up by an abundance of non-experimental studies, believe that preventing exsanguination from trauma requires the use of equivalent units of the three main blood components from the start. To achieve this, pre-thawed group-AB plasma must be constantly available such that it can be started as soon as, or almost as soon as, the first unit of universal donor packed red blood cells. This continues until the patient is stabilised, based on clinical signs and blood tests. Many civilian and military trauma centres have adopted this approach. On the other side of the controversy are authors who resist this move, and continue to advocate the traditional approach of ordering FFP and platelets only when one blood volume has been lost acutely, abnormal laboratory results are reported, or microvascular bleeding is obvious. In this latter camp, one important reason for not adopting the 1:1:1 approach is that it has never been validated through randomised controlled studies. This ignores the fact that neither approach has been so validated 3. Unfortunately, there are no randomised controlled trials comparing the two approaches. The data by Ponschab et al. 1 suggest that until we know for sure, frontline clinicians should take the commonsense approach that, in uncontrolled and profuse haemorrhage, one must replace what is lost, and what is lost is whole blood. Given what we know about the state of plasma fibrinogen and its importance in haemostasis and survival, perhaps the best resuscitating mixture in massive haemorrhage should be 1:1:1:1, with cryoprecipitate or the equivalent amount of fibrinogen added.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".