Metaanalysis on Medical Optimization of Shock in Polytrauma Patients Undergoing Surgery
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Background: Severe haemorrhage and haemorrhagic shock remain major causes of potentially preventable death following polytrauma. Contemporary management has evolved from predominantly crystalloid-based volume replacement toward haemostatic, time-sensitive, and physiology-guided resuscitation, but individual optimization strategies differ substantially in mechanism and strength of supporting evidence. Objective: To provide a structured narrative synthesis of contemporary evidence concerning medical optimization of haemorrhagic shock in adult polytrauma patients requiring emergency or definitive surgical management. Methods: MEDLINE/PubMed, Scopus, Web of Science, Embase, and the Cochrane Library were searched for literature published primarily between 2010 and 2025. Evidence concerning damage control resuscitation, balanced and massive transfusion, tranexamic acid, permissive hypotension, fluid management, vasopressor therapy, and haemodynamic or coagulation monitoring was synthesized according to clinical relevance, study design, directness, and consistency. No meta-analysis or pooled risk-of-bias assessment was performed. Results: The strongest comparative evidence supported early antifibrinolytic and coordinated blood-component therapy. CRASH-2 included 20,211 bleeding trauma patients and demonstrated reduced bleeding-related mortality with tranexamic acid, with subsequent analyses showing greater benefit with earlier administration. In the 680-patient PROPPR randomized trial, 1:1:1 plasma:platelet:red blood cell resuscitation improved haemostasis and reduced early exsanguination compared with 1:1:2 resuscitation, although overall 24-hour and 30-day mortality did not differ significantly. The 1,245-patient PROMMTT cohort further associated earlier plasma and platelet administration with improved survival. Evidence for restrictive crystalloid strategies, permissive hypotension, vasopressors, and advanced monitoring was more heterogeneous and context-dependent. Conclusion: Optimal management of traumatic haemorrhagic shock requires rapid haemorrhage control integrated with early haemostatic resuscitation and individualized physiological management. Evidence is strongest for timely tranexamic acid and coordinated blood-component therapy, while other strategies require selective application according to patient physiology and clinical context
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