Improvements in Early Mortality and Coagulopathy are Sustained Better in Patients With Blunt Trauma After Institution of a Massive Transfusion Protocol in a Civilian Level I Trauma Center

Dente, Christopher J.; Shaz, Beth H.; Nicholas, Jeffery M.; Harris, Robert S.; Wyrzykowski, Amy D.; Patel, Snehal S.; Shah, Asha; Vercruysse, Gary; Feliciano, David V.; Rozycki, Grace S.; Salomone, Jeffrey P.; Ingram, Walter L.

doi:10.1097/ta.0b013e3181a59ad5

Cited by 281 publications

(284 citation statements)

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“…Although there appears to be a clear reduction in mortality for injured soldiers, 10,[13][14][15]41 this finding has recently been questioned within the civilian cohort. 1,[21][22][23][24] Prior to the implementation of a formalized high plasma MTP (Table 1), mortality for patients who required a massive transfusion (≥ 10 units of RBCs) following grade 3, 4 or 5 hepatic injuries at our institution was 60%, 46% and 71%, respectively.…”

Section: Discussionmentioning

confidence: 98%

The impact of a massive transfusion protocol (1:1:1) on major hepatic injuries: Does it increase abdominal wall closure rates?

et al. 2013

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Background: Massive transfusion protocols (MTPs) using high plasma and platelet ratios for exsanguinating trauma patients are increasingly popular. Major liver injuries often require massive resuscitations and immediate hemorrhage control. Current published literature describes outcomes among patients with mixed patterns of injury. We sought to identify the effects of an MTP on patients with major liver trauma.Methods: Patients with grade 3, 4 or 5 liver injuries who required a massive blood component transfusion were analyzed. We compared patients with high plasma:red blood cell:platelet ratio (1:1:1) transfusions (2007)(2008)(2009)) with patients injured before the creation of an institutional MTP (2005MTP ( -2007.Results: Among 60 patients with major hepatic injuries, 35 (58%) underwent resuscitation after the implementation of an MTP. Patient and injury characteristics were similar between cohorts. Implementation of the MTP significantly improved plasma: red blood cell:platelet ratios and decreased crystalloid fluid resuscitation (p = 0.026). Rapid improvement in early acidosis and coagulopathy was superior with an MTP (p = 0.009). More patients in the MTP group also underwent primary abdominal fascial closure during their hospital stay (p = 0.021). This was most evident with grade 4 injuries (89% vs. 14%). The mean time to fascial closure was 4.2 days. The overall survival rate for all major liver injuries was not affected by an MTP (p = 0.61). Conclusion:The implementation of a formal MTP using high plasma and platelet ratios resulted in a substantial increase in abdominal wall approximation. This occurred concurrently to a decrease in the delivered volume of crystalloid fluid.Contexte : Les protocoles de transfusion massive (PTM) impliquant des rapports plasma:plaquettes élevés sont de plus en plus populaires pour traiter les patients atteints d'un traumatisme hémorragique. Les chirurgies majeures du foie requièrent souvent le déclenchement de protocoles de transfusion massive et une maîtrise immé-diate de l'hémorragie. La littérature actuelle décrit les résultats chez des patients victimes de divers types de traumatismes. Nous avons voulu mesurer les effets d'un PTM sur les patients ayant subi un traumatisme majeur au foie. Résultats : Sur 50 patients ayant subi des lésions hépatiques majeures, 35 (58 %) ont reçu des traitements de réanimation après la mise en place du PTM. Les caractéristiques propres aux patients et à leurs blessures étaient similaires entre les cohortes. L'application du PTM a significativement amélioré les rapports plasma:culots globulaires:plaquettes et réduit l'administration de cristalloïdes à des fins de réanimation liquidienne (p = 0,026). L'amélioration rapide de l'acidose naissante et de la coagulopathie a été meilleure avec le PTM (p = 0,009). Plus de patients du groupe soumis au PTM ont aussi subi une fermeture aponévrotique abdominale primaire durant leur séjour hospitalier (p = 0,021). Cela s'est surtout observé avec les lésions de grade 4 (89 % c. 14 %). Le délai moyen av...

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Section: Discussionmentioning

confidence: 98%

The impact of a massive transfusion protocol (1:1:1) on major hepatic injuries: Does it increase abdominal wall closure rates?

et al. 2013

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“…[32][33][34] This includes an immediate transfer to the operating theatre for hemorrhage control as the dominant guiding principle for improving the patient's probability of survival. The apparent success of "hypotensive resuscitation" in both the civilian and military contexts is also crucial.…”

Section: Initial Assessment and Resuscitationmentioning

confidence: 99%

Current management of penetrating torso trauma: nontherapeutic is not good enough anymore

Ball

2014

cjs

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“…Studies have confirmed the survival benefit of MTP. Dramatic reduction in many of the complications including organ failure has been observed in critically injured patients receiving massive transfusions [3,5,12,13].…”

Section: Massive Transfusion Protocol (Mtp)mentioning

confidence: 99%

Implementation of massive transfusion protocol (MTP) for trauma

Ellawala¹,

Gonsalkorala²,

Wijesiriwardena

2015

Sri Lanka j Surg

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Improvements in Early Mortality and Coagulopathy are Sustained Better in Patients With Blunt Trauma After Institution of a Massive Transfusion Protocol in a Civilian Level I Trauma Center

Abstract: In the civilian setting, aggressive use of FFP and platelets drastically reduces 24-hour mortality and early coagulopathy in patients with trauma. Reduction in 30 day mortality was only seen after blunt trauma in this small subset.

Cited by 281 publications

References 12 publications

The impact of a massive transfusion protocol (1:1:1) on major hepatic injuries: Does it increase abdominal wall closure rates?

The impact of a massive transfusion protocol (1:1:1) on major hepatic injuries: Does it increase abdominal wall closure rates?

Current management of penetrating torso trauma: nontherapeutic is not good enough anymore

Implementation of massive transfusion protocol (MTP) for trauma

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