Compliance with a massive transfusion protocol (MTP) impacts patient outcome

Bawazeer, Mohammed; Ahmed, Nasim; Izadi, Hooshang; McFarlan, Amanda; Nathens, Avery B.; Pavenski, Katerina

doi:10.1016/j.injury.2014.09.020

Cited by 75 publications

(69 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Therefore, at a local level, further effort is needed to improve both the MTP design and the logistics of its implementation so the target ratio is more often realized. Improving compliance to the protocol should be priority, as compliance independently improves survival . To that end, a human factors‐supported approach could be used to guide the design and implementation of a new support system for MTP to optimize the practice and performance of trauma and blood bank staff by gathering qualitative and quantitative data on current clinical practice regarding damage control resuscitation .…”

Section: Discussionmentioning

confidence: 99%

“…17 Cotton et al 7 found that only 27% of all trauma exsanguination protocol activations had full compliance during a performance improvement investigation and compliance could only be improved to a maximum of 50%. Bawazeer et al 17 found a mean compliance rate of 66% with a clear association between survival and a higher level of compliance. The retrospective design of our study did not allow us to evaluate compliance to our MTP.…”

Section: Compliancementioning

confidence: 99%

See 1 more Smart Citation

Ten‐year evolution of a massive transfusion protocol in a level 1 trauma centre: have outcomes improved?

Meij

Geeraedts

Kamphuis

et al. 2019

ANZ Journal of Surgery

View full text Add to dashboard Cite

BackgroundWe aimed to evaluate the evolution and implementation of the massive transfusion protocol (MTP) in an urban level 1 trauma centre. Most data on this topic comes from trauma centres with high exposure to life‐threatening haemorrhage. This study examines the effect of the introduction of an MTP in an Australian level 1 trauma centre.MethodsA retrospective study of prospectively collected data was performed over a 14‐year period. Three groups of trauma patients, who received more than 10 units of packed red blood cells (PRBC), were compared: a pre‐MTP group (2002–2006), an MTP‐I group (2006–2010) and an MTP‐II group (2010–2016) when the protocol was updated. Key outcomes were mortality, complications and number of blood products transfused.ResultsA total of 168 patients were included: 54 pre‐MTP patients were compared to 47 MTP‐I and 67 MTP‐II patients. In the MTP‐II group, fewer units of PRBC and platelets were administered within the first 24 h: 17 versus 14 (P = 0.01) and 12 versus 8 (P < 0.001), respectively. Less infections were noted in the MTP‐I group: 51.9% versus 31.9% (P = 0.04). No significant differences were found regarding mortality, ventilator days, intensive care unit and total hospital lengths of stay.ConclusionIntroduction of an MTP‐II in our level 1 civilian trauma centre significantly reduced the amount of PRBC and platelets used during damage control resuscitation. Introduction of the MTP did not directly impact survival or the incidence of complications. Nevertheless, this study reflects the complexity of real‐life medical care in a level 1 civilian trauma centre.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Compliancementioning

confidence: 99%

Ten‐year evolution of a massive transfusion protocol in a level 1 trauma centre: have outcomes improved?

Meij

Geeraedts

Kamphuis

et al. 2019

ANZ Journal of Surgery

View full text Add to dashboard Cite

show abstract

“…Following the prediction of massive transfusion, blood products should be delivered in a quick and timely manner at a high ratio of plasma, RBCs, and platelets. To achieve this quick response, not only the resuscitation staff but also the blood bank staff need to incorporate pre-implemented guidelines and flow charts for massive transfusion protocol (MTP) into their work flow [48,[66][67][68]. The protocol includes patient selection for activation of the MTP, description of the staff who should declare the activation, and the means by which the resuscitation team and the blood bank are informed of the protocol's activation.…”

Section: Massive Transfusion Protocolmentioning

confidence: 99%

“…Furthermore, compliance with the protocol affects patient outcome [66]. Because it is complex to transfuse blood products in a timely and safe manner, implementation of the MTP is essential for institutions caring for severely injured trauma patients.…”

Section: Massive Transfusion Protocolmentioning

confidence: 99%

Damage control resuscitation: a practical approach for severely hemorrhagic patients and its effects on trauma surgery

Mizobata

2017

j intensive care

View full text Add to dashboard Cite

Coagulopathy observed in trauma patients was thought to be a resuscitation-associated phenomenon. The replacement of lost and consumed coagulation factors was the mainstay in the resuscitation of hemorrhagic shock for many decades. Twenty years ago, damage control surgery (DCS) was implemented to challenge the coagulopathy of trauma. It consists of three steps: abbreviated surgery to control the hemorrhage and contamination, resuscitation in the intensive care unit (ICU), and planned re-operation with definitive surgery. The resuscitation strategy of DCS focused on the rapid reversal of acidosis and prevention of hypothermia through the first two steps. However, direct treatment of coagulopathy was not emphasized in DCS. Recently, better understanding of the pathophysiology of coagulopathy in trauma patients has led to the logical opinion that we should directly address this coagulopathy during major trauma resuscitation. Damage control resuscitation (DCR), the strategic approach to the trauma patient who presents in extremis, consists of balanced resuscitation, hemostatic resuscitation, and prevention of acidosis, hypothermia, and hypocalcemia. In balanced resuscitation, fluid administration is restricted and hypotension is allowed until definitive hemostatic measures begin. The administration of blood products consisting of fresh frozen plasma, packed red blood cells, and platelets, the ratio of which resembles whole blood, is recommended early in the resuscitation. DCR strategy is now the most beneficial measure available to address trauma-induced coagulopathy, and it can change the treatment strategy of trauma patients. DCS is now incorporated as a component of DCR. DCR as a structured intervention begins immediately after rapid initial assessment in the emergency room and progresses through the operating theater into the ICU in combination with DCS. By starting from ground zero with the performance of DCS, DCR allows the trauma surgeon to correct the coagulopathy of trauma. The effect of the reversal of coagulopathy in massively hemorrhagic patients may change the operative strategy with DCS.

show abstract

“…Therefore, protocols for massive transfusion have been developed and implemented in treatment algorithms [7–9]. Therapeutic concepts in severely injured patients with hemorrhagic shock have been noted to include administration of coagulation-supporting drugs without reducing the number of transfused packed red blood cells (PRBCs) [10, 11].…”

Section: Introductionmentioning

confidence: 99%

Association of an In-House Blood Bank with Therapy and Outcome in Severely Injured Patients: An Analysis of 18,573 Patients from the TraumaRegister DGU®

et al. 2016

View full text Add to dashboard Cite

IntroductionHemorrhagic shock remains one of the most common causes of death in severely injured patients. It is unknown to what extent the presence of a blood bank in a trauma center influences therapy and outcome in such patients.Material and MethodsWe retrospectively analyzed prospectively recorded data from the TraumaRegister DGU® and the TraumaNetzwerk DGU®. Inclusion criteria were Injury Severity Score (ISS) ≥ 16, primarily treated patients, and hospital admission 2 years before or after the audit process.ResultsComplete data sets of 18,573 patients were analyzed. Of 457 hospitals included, 33.3% had an in-house blood bank. In trauma centers with a blood bank (HospBB), packed red blood cells (PRBCs) (21.0% vs. 17.4%, p < 0.001) and fresh frozen plasma (FFP) (13.9% vs. 10.2%, p <0.001) were transfused significantly more often than in hospitals without a blood bank (Hosp0). However, no significant difference was found for in-hospital mortality (standard mortality ratio [SMR, 0.907 vs. 0.945; p = 0.25). In patients with clinically apparent shock on admission, no difference of performed transfusions were present between HospBB and Hosp0 (PRBCs, 51.4% vs. 50.4%, p = 0.67; FFP, 32.7% vs. 32.7%, p = 0.99), and no difference in in-hospital mortality was observed (SMR, 0.907 vs. 1.004; p = 0.21).DiscussionIn HospBB transfusions were performed more frequently in severely injured patients without positively affecting the 24h mortality or in-house mortality. Easy access may explain a more liberal transfusion concept.

show abstract

Compliance with a massive transfusion protocol (MTP) impacts patient outcome

Cited by 75 publications

References 17 publications

Ten‐year evolution of a massive transfusion protocol in a level 1 trauma centre: have outcomes improved?

Ten‐year evolution of a massive transfusion protocol in a level 1 trauma centre: have outcomes improved?

Damage control resuscitation: a practical approach for severely hemorrhagic patients and its effects on trauma surgery

Association of an In-House Blood Bank with Therapy and Outcome in Severely Injured Patients: An Analysis of 18,573 Patients from the TraumaRegister DGU®

Contact Info

Product

Resources

About