Major haemorrhage fatalities in the Australian national coronial database

Abstract

Major bleeding fatalities occurred across a diverse range of contexts, with trauma and gastrointestinal bleeding accounting for most deaths. The majority of patients did not survive to reach hospital. Major haemorrhage occurring entirely outside hospital may be underrecognised from analyses of datasets based primarily on traumatic or in-hospital bleeding. These findings have implications for management of pre-hospital resuscitation and development of clinical practice guidelines for identification and management of major bleeding in the community.

It is time to reconsider the risks of transfusing RhD negative females of childbearing potential with RhD positive red blood cells in bleeding emergencies

“…As discussed above, there is increasing evidence that the early intervention with blood products has a positive impact on survival in massively bleeding patients. This survival benefit is important when comparing the 0.3% overall risk of alloimmunization and fetal death to the fact that more than half of civilian preventable prehospital deaths are due to hemorrhage, approximately 85% of the 30,000 preventable deaths that occur every year in the United States happen before the patient arrives at the hospital; while in Australia, 69% of people whose major bleeding began in the community did not survive until hospital arrival …”

Clinical coding data algorithm to categorize type of gastrointestinal bleeding as a primary reason for massive transfusion: results from the Australian and New Zealand Massive Transfusion Registry

“…Furthermore, the cases in the ANZ‐MTR relate only to patients who reached hospital and received a MT there. In a recently published study of major haemorrhage‐related fatalities reported to the coroner, GIB accounted for 28% of all such deaths, of which only 13% survived to reach hospital and/or receive any transfusion .…”

Massive transfusions for critical bleeding: is everything old new again?

“…Another potentially important difference is the location of the patient at onset of bleeding, which for trauma patients is nearly always outside of hospital. However, the onset of fatal bleeding from GI haemorrhage and ruptured aneurysms commonly occurs at home (Gipson et al, ), and onset of other types of bleeding, such as surgical, nearly always occurs in hospital (Gipson et al, ; Mesar et al, ). These inherent differences pose challenges for introducing MT protocols that can be universally applied and for the management of out‐of‐hospital MT.…”