Abstract

QUINTANA-DIAZ, Manuel; GARAY-FERNANDEZ, Manuel  and  ARIZA, Fredy. Advancing in the understanding of coagulopathy during hemorrhagic shock: From the triad to the deadly pentad. Rev. colomb. anestesiol. [online]. 2022, vol.50, n.4, e301.  Epub Nov 02, 2022. ISSN 0120-3347.  https://doi.org/10.5554/22562087.e1038.

The deadly triad concept represented a dogma in the definition of poor outcomes and death associated with major bleeding in trauma. This model of end-stage disease was then rapidly transferred to other major bleeding scenarios. However, and notwithstanding the fact that it represented a severe scenario, the original triad fails to establish a sequence, which would be relevant when defining the objectives during the initial treatment of severe bleeding. Likewise, this model admits only one scenario where all the conditions shall co-exist, knowing that each one of them contributes with a different risk burden. Based on a structured review, we propose a pentad model that includes a natural pattern of events occurring with hypoxemia as the main trigger for the development of hypocalcemia, hyperglycemia, acidosis and hypothermia, as surrogates of multi-organ impairment. This severity model of major bleeding considers coagulopathy as a result of the failure to restore the initial components of damage.

Keywords : Coagulation disorders; Hemorrhage; Acidosis; Hypothermia; Calcium; Hyperglycemia; Anesthesiology.

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