Massive hemorrhage protocol survey: Marked variability and absent in one-third of hospitals in Ontario, Canada

Chin, Victoria; Cope, Stephanie; Thompson, Troy; Nascimento, Barto; Pavenski, Katerina; Callum, Jeannie

doi:10.1016/j.injury.2018.11.026

Cited by 14 publications

(11 citation statements)

References 37 publications

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“…A recent observational study of ROTEM-guided transfusion algorithm in the cardiovascular surgery patients also showed a 12% reduction in plasma use [41]. Perhaps, wider adoption of viscoelastic-guided transfusion therapy may increase appropriate plasma use [42]. The INR was not measured before the plasma event in 18% of patients (and The strengths of this study include capturing a large number of consecutive plasma transfusion events across multiple institutions, where the data were extracted in a consistent manner across sites with added information regarding timing of transfusions and the date on which procedures were performed.…”

Section: Discussionmentioning

confidence: 99%

“…A recent observational study of ROTEM‐guided transfusion algorithm in the cardiovascular surgery patients also showed a 12% reduction in plasma use [41]. Perhaps, wider adoption of viscoelastic‐guided transfusion therapy may increase appropriate plasma use [42]. The INR was not measured before the plasma event in 18% of patients (and ranged across sites from 2% to 23%) suggesting that point‐of‐care‐testing may assist with improving plasma transfusion practice.…”

Section: Discussionmentioning

confidence: 99%

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Plasma transfusion practices: A multicentre electronic audit

et al. 2022

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Background and Objectives: Plasma is often transfused to patients with bleeding or requiring invasive procedures and with abnormal tests of coagulation. Chart audits find half of plasma transfusions unnecessary, resulting in avoidable complications and costs. This multicentre electronic audit was conducted to determine the proportion of plasma transfused without an indication and/or at a sub-therapeutic dose.Methods: Data were extracted on adult inpatients in 2017 at five academic sites from the hospital electronic chart, laboratory information systems and the Canadian Institute for Health Information Discharge Abstract Database. Electronic criteria for plasma transfusion outside recommended indications were: (1) international normalized ratio (INR) < 1.5 with no to moderate bleeding; (2) INR ≥ 1.5, with no to mild bleeding and no planned procedures; and (3) no INR before or after plasma infusion. Sub-therapeutic dose was defined as ≤2 units transfused.Results: In 1 year, 2590 patients received 6088 plasma transfusions encompassing 11,490 units of plasma occurred at the five sites. 77.7% of events were either outside indications or under-dosed. Of these, 34.8% of plasma orders had no

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Plasma transfusion practices: A multicentre electronic audit

et al. 2022

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“…Although the lists of statements are not exhaustive, we hope that they address the current widespread variability in MHP structure. 14,15 Both the modified Delphi process and the external stakeholder consultation assisted with statement construction to ensure clarity for both experts in transfusion medicine and health care personnel working outside of the laboratory. This consensus document created by the modified Delphi method is a powerful tool that is broadly applicable and adaptable to many hospital settings.…”

Section: Discussionmentioning

confidence: 99%

A regional massive hemorrhage protocol developed through a modified Delphi technique

Callum

Petrosoniak²,

McVey³

et al. 2019

cmajo

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assive bleeding is a leading preventable cause of death following trauma, childbirth and surgery. 1-3 There were 5.1 million deaths after traumatic injury worldwide in 2010, mostly affecting young people, accounting for nearly 10% of all deaths. 4 In the United States, it is estimated that up to 20% of such deaths are the direct result of preventable hemorrhage. 4-7 Management of unstable hemorrhagic shock is centred on stabilizing the patient with prompt transfusion of blood components, and rapid identification and treatment of the source of bleeding. Patient outcome is dependent on the availability of rapid definitive surgical intervention, support of a transfusion medicine and clinical laboratory, prompt access to hemostatic agents and care provided by a high-performing interdisciplinary team. 8 In the trauma literature, protocolized delivery of massive transfusion streamlines the complexities

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“…Only United Kingdom had undertaken a nationwide audit in 2018 and this included all clinical settings in adults [13]. In 2018, a provincial survey of MHP of all hospitals was conducted in Canada across all clinical settings [29]: this showed marked variability, and failed to include the eight key quality metrics deemed necessary in the Ontario MHP, which was made public in 2021 [24]. Canada is planning to conduct an audit in 2022.…”

Section: Summary Of Responsesmentioning

confidence: 99%