Thread by @CritCareReviews

➡️ Throughout history, the most mystical substance of all has been blood
➡️ It has been coveted and desired
➡️ Fought for and defended
➡️ Stolen, yet freely given

A 🧵

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➡️ Blood has always been a symbol of power
➡️ In Greek mythology, ichor, the blood of the Gods, was a golden fluid
➡️ It was immortal, pure, & untainted by human weaknesses
➡️ The Gods derived their divine powers & longevity from it

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➡️ Blood has been revered for its restorative properties
➡️ Elizabeth Báthory, a 16th-century Hungarian noblewoman, allegedly killed hundreds of young girls & women
➡️ She bathed in their blood to maintain her youth & beauty

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➡️ Blood was highly valued
➡️ In 1487, the Aztec ruler Ahuitzotl ordered a blood sacrifice to honor the gods Huitzilopochtli & Tlaloc
➡️ Over 4 days, up to 80,000 captured warriors had their still-beating hearts cut out on the Great Temple's sacrificial altar

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➡️ Their bodies were tossed down the temple side and dismembered below
➡️ The skulls were added to the tzompantli, or skull rack
➡️ The Aztecs believed that Huitzilopochtli, the Sun God, required nourishment from human blood to continue his daily journey across the sky

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➡️ Blood is also deeply personal, a reflection of one's uniqueness & being
➡️ Tales of its theft are psychologically traumatic
➡️ One of the best known stories capturing this fear is Bram Stoker's Dracula
➡️ Written in 1897, it remains hugely popular & terrifying

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➡️ Vital for life, blood is also precious
➡️ Early attempts to halt bleeding involved many different substances from the natural world
➡️ Spiderwebs have been used in many civilisations over time
➡️ In addition to their strong laced structure, they also contain vitamin K

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➡️ In WW1 soldiers from both sides used Sphagnum (bog) moss
➡️ With absorbent & antiseptic properties, it promoted clotting & prevent infection
➡️ The moss could hold 22 times its volume in blood
➡️ It also reduced wound pH, preventing microbial growth

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➡️ Not all efforts were successful.....
➡️ In ancient Rome, the physician Galen documented the use of horse dung for bleeding
➡️ It was applied directly to the wound
➡️ The warmth and pressure from the dung were believed to promote clotting & prevent infection

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➡️ Today, haemostatic measures are slightly more scientific

➡️ Tranexamic acid has been tested and is currently recommended for major traumatic haemorrhage
➡️ The upcoming @PATCHTrial results will confirm or refute the findings of previous studies like CRASH-2

10/16

@PATCHTrial ➡️ Plasma fibrinogen levels drop in traumatic haemorrhage
➡️ Fresh frozen plasma contains ~ 70% of the clotting factors of fresh blood
➡️ FFP alone is unable to increase plasma fibrinogen to > 2g/L, similar to normal plasma

11/16

@PATCHTrial ➡️ Cryoprecipitate, rich in fibrinogen, can increase the levels of this haemostatic factor
➡️ Whether this is beneficial in traumatic haemorrhage is unknown
➡️ The upcoming @CRYOSTAT_2 results presentation at #CCR23 will provide an answer

12/16

@PATCHTrial @CRYOSTAT_2 ➡️ 4-factor prothrombin complex concentrate contains coagulation factors II, VII, IX, & X plus proteins S and C
➡️ It was hoped it would decrease blood product use in trauma resuscitation & improve outcomes
➡️ Sadly, it didn't, but did cause more thrombotic events

13/16

@PATCHTrial @CRYOSTAT_2 ➡️ Published in @JAMA_current current last month, the PROCOAG trial adds to the evidence base for haemostatic resuscitation in trauma
➡️ Along with @CRYOSTAT_2, @PATCHTrial & @UKREBOATrial, the best recent trauma trials will be presented together at #CCR23

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@PATCHTrial @CRYOSTAT_2 @JAMA_current @UKREBOATrial ➡️ Join us in @TitanicBelfast to hear the discussions at #CCR23
➡️ The chief investigators for all 4 trials will be present
➡️ Pierre Bouzat will present the PROCOAG trial
➡️ How will we haemostatically resuscitate patients post #CCR23?
criticalcarereviews.com/meetings/ccr23

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@PATCHTrial @CRYOSTAT_2 @JAMA_current @UKREBOATrial @TitanicBelfast ➡️ #CCR23 is supported by
🔴 @VisitBelfast
🔴 @belfastcc
🔴 @NITouristBoard
🔴 @BelfastTrust

See you in Belfast in June

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