Therefore, correction of coagulopathy should not be delayed until laboratory values are available to guide therapy and goals of care. These data highlight the importance of recognizing the early onset of the coagulopathy of trauma at the time of injury, as well as endothelial damage, which plasma has been shown to correct. Looking back at the first decade of war in Iraq, 33% of combat casualties were coagulopathic on admission, which correlated with a fivefold increase in mortality. Analysis of the German Trauma Registry yielded similar results with rates of coagulopathy up to 34% as well as a direct correlation between the amount of crystalloid received prehospital and an increasing degree of coagulopathy. Coagulopathic patients have significantly higher mortality rates, while the degree of coagulopathy correlated with the severity of injury. Multiple US large center retrospective cohorts showed that 24–28% of severely injured trauma patients are found to be coagulopathic on admission. In 1945, Beecher noted that “Plasma gives more time to get whole blood into the patient”. The role of plasma in DCR has been reaffirmed time and time again. Plasma transfusion is an essential part of this approach and remains a significant logistical challenge even today, hence the need for a reliable, shelf-stable, easy-to-carry and administer plasma product such as dried plasma. Rapid treatment utilizing damage control resuscitation (DCR) with blood components mimicking whole blood in the setting of permissive hypotension, avoiding crystalloid and colloid, followed by prompt surgical hemorrhage control, is the best strategy to prevent traumatic hemorrhagic death and the onset of the lethal triad.
The lethal triad of hypothermia, acidosis, and acute coagulopathy of trauma is well recognized as a common pathway to irreversible shock and death. For patients who survive long enough to make it to a hospital, the median time to death from hemorrhage is 90–150 min after admission. Contrary to the classical teachings of the “golden hour,” in patients with severe truncal hemorrhage, peak mortality occurs at 30 min.
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