Table 3 Specific research opportunities in the field of trauma, critical bleeding, and transfusion

Strategies for blood resuscitation of trauma patients with critical bleeding

• Prospective randomized head-to-head comparison trials of goal-directed, ratio only, or combination strategies for blood support in trauma patients.

• Immune consequences of exposure to large quantities of incompatible group A and group B soluble antigens found in ABO-compatible but nonidentical plasma.

• Prospective randomized studies that examine effects of colloid versus crystalloid resuscitation.

• Studies of clinical hemostatic efficacy and adverse effects of stored thawed plasma compared with plasma thawed within 24 hours, including the efficacy and adverse effects on nontrauma patients who might receive such products.

Other blood therapies

• Studies comparing triggers for fibrinogen supplementation, different sources of fibrinogen, and methods to monitor effect of transfusion of fibrinogen-containing products.

• Preclinical studies of the effect of novel inhibitors of the protein C pathway on the acute coagulopathy of trauma.

Conditions other than trauma

• Identification of features common to all patients receiving sustained high rates of transfusion as well as research designed to identify clinical, laboratory, and treatment features unique to critical bleeding in trauma, cardiac surgery, obstetrics, and pediatrics.

Clinical pathways for delivery of transfusion support in trauma complicated by critical bleeding

• Studies of the value effect of massive transfusion protocols.

• Studies addressing the difficulty and the process of withdrawing therapy among patients with negligible physiologic chance of survival.

• Studies of access to massive transfusion strategies in remote healthcare settings.

Coagulation testing and the acute coagulopathy of trauma

• Studies of the value of various specific laboratory tests to support the transfusion of massively bleeding trauma patients. These to include both classical tests of hemostasis and thromboelastography/rotational thromboelastometry testing.

• Well-designed, controlled investigation of topical hemostasis therapy including topical application of blood components and the topical application of procoagulant drugs/agents.