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Module 4: Thoracic Injuries

Segment 6: Hemorrhage Management

References labeled PEDS contain a pediatric element or primary focus.

Topic: Hemorrhage Management

  • Bernhardt IM, Moore EE, Sauaia A, et al. Timing of trauma deaths due to uncontrolled bleeding have not changed in three decades: A multicenter study of patients in hemorrhagic shock. Am J Surg. 2025;250:116510. doi: 10.1016/j.amjsurg.2025.116510 https://pubmed.ncbi.nlm.nih.gov/40706451/.
  • Bezati S, Ventoulis I, Verras C, et al. Major bleeding in the emergency department: A practical guide for optimal management. J Clin Med. 2025;14(3) doi: 10.3390/jcm14030784 https://pubmed.ncbi.nlm.nih.gov/39941455/.
  • Bonanno FG. Management of hemorrhagic shock: Physiology, approach, timing, and strategies. J Clin Med. 2022;12(1) doi: 10.3390/jcm12010260 https://pubmed.ncbi.nlm.nih.gov/36615060/.
  • Bulger EM, Perina DG, Qasim Z, et al. Clinical use of resuscitative endovascular balloon occlusion of the aorta (REBOA) in civilian trauma systems in the USA, 2019: a joint statement from the American College of Surgeons Committee on Trauma, the American College of Emergency Physicians, the National Association of Emergency Medical Services Physicians and the National Association of Emergency Medical Technicians. Trauma Surg Acute Care Open. 2019;4(1):e000376. doi: 10.1136/tsaco-2019-000376 https://pubmed.ncbi.nlm.nih.gov/31673635/.
  • Butler F, Holcomb JB, Dorlac W, et al. Who needs a tourniquet? And who does not? Lessons learned from a review of tourniquet use in the Russo-Ukrainian war. J Trauma Acute Care Surg. 2024;97(2S Suppl 1):S45-s54. doi: 10.1097/ta.0000000000004395 https://pubmed.ncbi.nlm.nih.gov/38996420/.
  • Caillard A, Collins S, Gurney J, et al. Management of life-threatening bleeding: Application of Learned Experiences from the Critical Care Clinical Trialists (3CT) Workshop. Shock. 2025;doi: 10.1097/shk.0000000000002735 https://pubmed.ncbi.nlm.nih.gov/41144948/.
  • Castellini G, Gianola S, Biffi A, et al. Resuscitative endovascular balloon occlusion of the aorta (REBOA) in patients with major trauma and uncontrolled haemorrhagic shock: a systematic review with meta-analysis. World J Emerg Surg. 2021;16(1):41. doi: 10.1186/s13017-021-00386-9 https://pubmed.ncbi.nlm.nih.gov/34384452/.
  • Cau MF, Ali-Mohamad N, Yeh H, et al. Percutaneous delivery of self-propelling thrombin-containing powder increases survival from non-compressible truncal hemorrhage in a swine model of coagulopathy and hypothermia. J Trauma Acute Care Surg. 2022;doi: 10.1097/ta.0000000000003670 https://pubmed.ncbi.nlm.nih.gov/35545803/.
  • Chang R, Fox EE, Greene TJ, et al. Multicenter retrospective study of noncompressible torso hemorrhage: Anatomic locations of bleeding and comparison of endovascular versus open approach. J Trauma Acute Care Surg. 2017;83(1):11-18. doi: 10.1097/ta.0000000000001530 https://pubmed.ncbi.nlm.nih.gov/28632581/.
  • Chang R, Kerby JD, Kalkwarf KJ, et al. Earlier time to hemostasis is associated with decreased mortality and rate of complications: Results from the Pragmatic Randomized Optimal Platelet and Plasma Ratio trial. J Trauma Acute Care Surg. 2019;87(2):342-349. doi: 10.1097/ta.0000000000002263 https://pubmed.ncbi.nlm.nih.gov/31349348/.
  • Cotton BA. Facing futility in hemorrhagic shock: when to say ‘when’ in children and adults. Trauma Surg Acute Care Open. 2024;9(Suppl 2):e001448. doi: 10.1136/tsaco-2024-001448 https://pubmed.ncbi.nlm.nih.gov/38646027/. PEDS
  • Cralley AL, Vigneshwar N, Moore EE, et al. Zone 1 endovascular balloon occlusion of the aorta vs resuscitative thoracotomy for patient resuscitation after severe hemorrhagic shock. JAMA Surg. 2023;158(2):140-150. doi: 10.1001/jamasurg.2022.6393 https://pubmed.ncbi.nlm.nih.gov/36542395/.
  • Day MW. Control of traumatic extremity hemorrhage. Crit Care Nurse. 2016;36(1):40-51. doi: 10.4037/ccn2016871 https://pubmed.ncbi.nlm.nih.gov/26830179/.
  • Deeb A-P, Guyette FX, Daley BJ, et al. Time to early resuscitative intervention association with mortality in trauma patients at risk for hemorrhage. J Trauma Acute Care Surg. 2023;94(4):504-512. doi: 10.1097/ta.0000000000003820 https://pubmed.ncbi.nlm.nih.gov/36728324/.
  • Di Carlo S, Cavallaro G, Palomeque K, et al. Prehospital hemorrhage assessment criteria: A concise review. J Trauma Nurs. 2021;28(5):332-338. doi: 10.1097/jtn.0000000000000608 https://pubmed.ncbi.nlm.nih.gov/34491952/.
  • Emergency Nurses Association. ENA position statement: Hemorrhage control. J Emerg Nurs. 2022;48(4):460-4. doi: 10.1016/j.jen.2022.03.005 https://pubmed.ncbi.nlm.nih.gov/35787775/.
  • Furman L, Feeney EV, Bizri N, et al. Increased prehospital to total blood product administration associated with improved hospital outcomes: A secondary analysis of hemorrhagic shock trials. J Trauma Acute Care Surg. 2026;101(1):39-47. doi: 10.1097/ta.0000000000004970 https://pubmed.ncbi.nlm.nih.gov/41941349/.
  • Gao Y, Sarode A, Kokoroskos N, et al. A polymer-based systemic hemostatic agent. Science Adv. 2020;6(31):eaba0588. doi: 10.1126/sciadv.aba0588 https://pubmed.ncbi.nlm.nih.gov/32775633/.
  • Hashmi ZG, Hu PJ, Jansen JO, et al. Characteristics and outcomes of prehospital tourniquet use for trauma in the United States. Prehosp Emerg Care. 2023;27(1):31-37. doi: 10.1080/10903127.2021.2025283 https://pubmed.ncbi.nlm.nih.gov/34990299/.
  • Holcomb JB, Dorlac WC, Drew BG, et al. Rethinking limb tourniquet conversion in the prehospital environment. J Trauma Acute Care Surg. 2023;95(6):e54-e60. doi: 10.1097/ta.0000000000004134 https://pubmed.ncbi.nlm.nih.gov/37678162/.
  • Jamal L, Saini A, Quencer K, et al. Emerging approaches to pre-hospital hemorrhage control: a narrative review. Ann Transl Med. 2021;9(14):1192. doi: 10.21037/atm-20-5452 https://pubmed.ncbi.nlm.nih.gov/34430633/.
  • Johnston LR, Parker WJ, Walker P, et al. Tourniquets. Curr Trauma Rep. 2024;10(4):72-77. doi: 10.1007/s40719-024-00272-0 https://link.springer.com/article/10.1007/s40719-024-00272-0.
  • Kim K, Shim H, Jung PY, et al. Effectiveness of kaolin-impregnated hemostatic gauze use in preperitoneal pelvic packing for patients with pelvic fractures and hemodynamic instability: A propensity score matching analysis. PLoS One. 2020;15(7):e0236645. doi: 10.1371/journal.pone.0236645 https://pubmed.ncbi.nlm.nih.gov/32706824/.
  • Lammers D, Henry R, Betzold R, et al. Pushing advanced hemorrhage control interventions forward: Reducing prehospital mortality from traumatic hemorrhage through further adoption of effective military prehospital strategies. J Trauma Acute Care Surg. 2025;99(3S Suppl 1):S126-s132. doi: 10.1097/ta.0000000000004674 https://pubmed.ncbi.nlm.nih.gov/40492888/.
  • Lammers D, Henry R, McClellan J, et al. Prolonged tourniquet use in extremity trauma: What you need to know. J Trauma Acute Care Surg. 2026;doi: 10.1097/ta.0000000000005108 https://pubmed.ncbi.nlm.nih.gov/42312871/.
  • Meza Monge K, Rosa C, Sublette C, et al. Navigating hemorrhagic shock: Biomarkers, therapies, and challenges in clinical care. Biomedicines. 2024;12(12) doi: 10.3390/biomedicines12122864 https://pubmed.ncbi.nlm.nih.gov/39767770/.
  • Mutschler M, Nienaber U, Brockamp T, et al. A critical reappraisal of the ATLS classification of hypovolaemic shock: does it really reflect clinical reality? Resuscitation. 2013;84(3):309-13. doi: 10.1016/j.resuscitation.2012.07.012 https://pubmed.ncbi.nlm.nih.gov/22835498/.
  • Okum SE, Mehta A, Lunardi N, et al. Could we have stopped the bleed? An examination of 5,765 homicide autopsies across 13 years. J Am Coll Surg. 2026;242(3):562-571. doi: 10.1097/xcs.0000000000001695 https://pubmed.ncbi.nlm.nih.gov/41701567/.
  • Peng HT. Hemostatic agents for prehospital hemorrhage control: a narrative review. Mil Med Res. 2020;7(1):13. doi: 10.1186/s40779-020-00241-z https://pubmed.ncbi.nlm.nih.gov/32209132/.
  • Qasim Z, Butler FK, Holcomb JB, et al. Selective prehospital advanced resuscitative care: Developing a strategy to prevent prehospital deaths from noncompressible torso hemorrhage. Shock. 2022;57(1):7-14. doi: 10.1097/shk.0000000000001816 https://pubmed.ncbi.nlm.nih.gov/34033617/.
  • Rasmussen TE. Focused empiricism and the efficacy of resuscitative endovascular balloon occlusion of the aorta. JAMA Surg. 2023;158(2):150-151. doi: 10.1001/jamasurg.2022.6430 https://pubmed.ncbi.nlm.nih.gov/36542387/.
  • Rittblat M, Gendler S, Tsur N, et al. The cost of saving lives: Complications arising from prehospital tourniquet application. Acad Emerg Med. 2024;doi: 10.1111/acem.15070 https://pubmed.ncbi.nlm.nih.gov/39686666/.
  • Schroll R, Smith A, Alabaster K, et al. AAST multicenter prospective analysis of prehospital tourniquet use for extremity trauma. J Trauma Acute Care Surg. 2022;92(6):997-1004. doi: 10.1097/ta.0000000000003555 https://pubmed.ncbi.nlm.nih.gov/35609289/.
  • Spiegel S, Baker AM. EMS junctional hemorrhage control. StatPearls. StatPearls Publishing; 2026. https://www.ncbi.nlm.nih.gov/books/NBK597371/.
  • Tisherman SA, Brenner ML. Contemporary adjuncts to hemorrhage control. JAMA. 2023;doi: 10.1001/jama.2023.16135 https://pubmed.ncbi.nlm.nih.gov/37824165/.
  • Veazey SR, Mike JF, Hull DR, et al. Next-generation tourniquet: Recommendations for future capabilities and design requirements. J Trauma Acute Care Surg. 2024;96(6):949-954. doi: 10.1097/ta.0000000000004237 https://pubmed.ncbi.nlm.nih.gov/38189454/.
  • Wagner HJ, Goossen K, Hilbert-Carius P, et al. Endovascular management of haemorrhage and vascular lesions in patients with multiple and/or severe injuries: a systematic review and clinical practice guideline update. Eur J Trauma Emerg Surg. 2025;51(1):22. doi: 10.1007/s00068-024-02719-0 https://pubmed.ncbi.nlm.nih.gov/39820621/.
  • Wahlgren CM, Aylwin C, Davenport RA, et al. Editor’s Choice—European Society for Vascular Surgery (ESVS) 2025 clinical practice guidelines on the management of vascular trauma. Eur J Vasc Endovasc Surg. 2025;69(2):179-237. doi: 10.1016/j.ejvs.2024.12.018 https://pubmed.ncbi.nlm.nih.gov/39809666/.
  • Wang X, Zhang X, Yang X, et al. An antibacterial and antiadhesion in situ forming hydrogel with Sol-Spray system for noncompressible hemostasis. ACS Appl Mater Interfaces. 2023;15(1):662-676. doi: 10.1021/acsami.2c19662 https://pubmed.ncbi.nlm.nih.gov/36562696/.
  • Woolley T, Thompson P, Kirkman E, et al. Trauma Hemostasis and Oxygenation Research Network position paper on the role of hypotensive resuscitation as part of remote damage control resuscitation. J Trauma Acute Care Surg. 2018;84(6S Suppl 1):S3-s13. doi: 10.1097/ta.0000000000001856 https://pubmed.ncbi.nlm.nih.gov/29799823/.
  • Yin G, Radulovic N, O’Neill M, et al. Predictors of transfusion in trauma and their utility in the prehospital environment: A scoping review. Prehosp Emerg Care. 2023;27(5):575-585. doi: 10.1080/10903127.2022.2120935 https://pubmed.ncbi.nlm.nih.gov/36066217/.
  • Zhang LY, Zhang HY. Torso hemorrhage: noncompressible? Never say never. Eur J Med Res. 2024;29(1):153. doi: 10.1186/s40001-024-01760-4 https://pubmed.ncbi.nlm.nih.gov/38448977/.

Topic: Blood replacement

  • A compendium of transfusion practice guidelines. American Red Cross; 2021. https://www.redcross.org/content/dam/redcrossblood/hospital-page-documents/334401_compendium_v04jan2021_bookmarkedworking_rwv01.pdf.
  • Flommersfeld S, Mand C, Kuhne CA, et al. Unmatched type O RhD+ red blood cells in multiple injured patients. Transfus Med Hemother. 2018;45(3):158-161. doi: 10.1159/000485388 https://pubmed.ncbi.nlm.nih.gov/29928169/.
  • Gammon RR, Almozain N, Hermelin D, et al. RhD-alloimmunization in adult and pediatric trauma patients. Transfus Med Rev. 2024;38(4):150842. doi: 10.1016/j.tmrv.2024.150842 https://pubmed.ncbi.nlm.nih.gov/39127022/. PEDS
  • Henry R, Coleman JR, Holcomb JB, et al. Post-Transfusion Management of RhD-Negative Females of Childbearing Potential Who Receive RhD-Positive Low-Titer Group O Whole Blood and Red Blood Cells During Trauma Resuscitation: A Joint Position Statement and Resource Document of the American College of Surgeons Committee on Trauma (ACS-COT), Prehospital Blood Transfusion Coalition (PBTC), National Association of Emergency Medical Services Physicians (NAEMSP), Trauma Hemostasis and Oxygenation Research (THOR) Network, and Allo Hope Foundation (AHF). J Am Coll Surg. 2026;doi: 10.1097/xcs.0000000000002099 https://pubmed.ncbi.nlm.nih.gov/42490058/.
  • Knowles C, Raitt J. Blood transfusion - moving from what to how. Scand J Trauma Resusc Emerg Med. 2025;33(1):118. doi: 10.1186/s13049-025-01428-w https://pubmed.ncbi.nlm.nih.gov/40619399/.
  • Kuehn B. Could universal donor blood be made in the laboratory? JAMA. 2023;doi: 10.1001/jama.2023.19288 https://pubmed.ncbi.nlm.nih.gov/37824127/.
  • Leeper CM, Andrews JC, Spinella PC, et al. Emergent transfusion and hemolytic disease of the fetus and newborn risk mitigation in females of childbearing potential with life-threatening bleeding: A clinical practice guideline. J Am Coll Surg. 2026;242(5):1406-1416. doi: 10.1097/xcs.0000000000001732 https://pubmed.ncbi.nlm.nih.gov/41400561/. PEDS
  • Matthew JL, Randall MS, Holly O, et al. Prehospital blood transfusion coalition clinical practice guideline for civilian emergency medical services. Trauma Surg Acute Care Open. 2025;10(3):e001931. doi: 10.1136/tsaco-2025-001931 https://pubmed.ncbi.nlm.nih.gov/40692732/.
  • Murphy TO, Spinella PC, Young PP, et al. RhD-Positive Transfusion in Females of Childbearing Potential in Hemorrhagic Shock: Risk, Reality, and Policy. Prehosp Emerg Care. 2026:1-17. doi: 10.1080/10903127.2026.2701877 https://pubmed.ncbi.nlm.nih.gov/42441900/.
  • Purvis CD, Bavishi D, Rigi M, et al. What is the Incidence of Early Antibody Formation after Resuscitation of Hemorrhage? A Comparison of RH(D)+ Whole Blood and RH(D)- Red Blood Cells in 3,531 Trauma Patients. Ann Surg. 2026;doi: 10.1097/sla.0000000000007137 https://pubmed.ncbi.nlm.nih.gov/42328743/.
  • Raasveld SJ, de Bruin S, Reuland MC, et al. Red blood cell transfusion in the intensive care unit. JAMA. 2023;doi: 10.1001/jama.2023.20737 https://pubmed.ncbi.nlm.nih.gov/37824112/.
  • Ramos J. What would mother say? Whole blood and RhD alloimmunization in trauma resuscitation. J Emerg Nurs. 2026;52(1):28-33. doi: 10.1016/j.jen.2025.09.005 https://pubmed.ncbi.nlm.nih.gov/41490903/.
  • Seheult JN, Stram MN, Pearce T, et al. The risk to future pregnancies of transfusing Rh(D)-negative females of childbearing potential with Rh(D)-positive red blood cells during trauma resuscitation is dependent on their age at transfusion. Vox Sang. 2021;116(7):831-840. doi: 10.1111/vox.13065 https://pubmed.ncbi.nlm.nih.gov/33491789/. PEDS
  • Uhlich R, Hu P, Yazer M, et al. The females have spoken: A patient-centered national survey on the administration of emergent transfusions with the potential for future fetal harm. J Trauma Acute Care Surg. 2023;94(6):791-797. doi: 10.1097/ta.0000000000003914 https://pubmed.ncbi.nlm.nih.gov/36808128/.
  • Williams J, Merutka N, Meyer D, et al. Safety profile and impact of low-titer group O whole blood for emergency use in trauma. J Trauma Acute Care Surg. 2020;88(1):87-93. doi: 10.1097/ta.0000000000002498 https://pubmed.ncbi.nlm.nih.gov/31464874/.
  • Yamamoto K, Sakurai R, Motosuke M. Fully-automatic blood-typing chip exploiting bubbles for quick dilution and detection. Biomicrofluidics. 2020;14(2):024111. doi: 10.1063/5.0006264 https://pubmed.ncbi.nlm.nih.gov/32549921/.
  • Yazer M, Triulzi D, Sperry J, et al. Rate of RhD-alloimmunization after the transfusion of RhD-positive red blood cell containing products among injured patients of childbearing age: single center experience and narrative literature review. Hematol. 2021;26(1):321-327. doi: 10.1080/16078454.2021.1905395 https://pubmed.ncbi.nlm.nih.gov/33775237/.
  • Yazer MH, Panko G, Holcomb JB, et al. Not as “D”eadly as once thought – the risk of D-alloimmunization and hemolytic disease of the fetus and newborn following RhD-positive transfusion in trauma. Hematol. 2023;28(1):2161215. doi: 10.1080/16078454.2022.2161215 https://pubmed.ncbi.nlm.nih.gov/36607150/.
  • Yu G, Siegler J, Hayes J, et al. Attitudes of American adult women toward accepting RhD-mismatched transfusions in bleeding emergencies. Transfusion. 2022;62(S1):S211-S217. doi: 10.1111/trf.16981 https://pubmed.ncbi.nlm.nih.gov/35753036/.