Massive transfusion in trauma: blood product ratios should be measured at 6 hours

Abstract

Implementation of MTP resulted in earlier balanced transfusion. The difference between the FFP/PRBC ratios of the two types of resuscitations levelled by 24 h. The efficacy of component therapy delivery should be measured earlier than 24 h.

Emergency red cells first: Rapid response or speed bump? The evolution of a massive transfusion protocol for trauma in a single UK centre

“…The findings, although greater than expected, were consistent with recent reports of pre-MTP emergency RCC use [18]. A median of two additional emergency RCC units was used i.e.…”

“…Until now it has been difficult to discern from the literature how accurately clinicians predict massive haemorrhage, target transfusion use, and what factors influence these issues. This lack of clarity has arisen from the practice of excluding cases where an MTP has been activated for patients requiring little or no transfusion [4,18] and a general paucity of information about the size and composition of the denominator groups [3,19]. The only brief insights into this issue have been provided by Hendrickson et al [20] Morse et al [21] and Sinha et al [22] who, in their respective paediatric, adult non-trauma and mixed MTP groups, have all noted MTP activation can be followed by little or no transfusion.…”

Reverse survivor bias in observational studies involving cohorts: a lesson from '1:1' trauma studies

“…5,10,11 However, all these exercises are of value only if we have data from those first hours after trauma. As centres are making thawed plasma immediately available to trauma patients, studies such as PROMMTT 6,10,11 will possibly shed new light on this controversy.…”

“…9,10 Hence FFP therapy, if effective, is likely to be so during the early phase. After a patient has been stabilised, additional FFP is unlikely to be of high value.…”

Choice of General Anesthetics for Trauma Patients

“…After the control of acute hemorrhage, ongoing resuscitation continues using warmed blood components administered at high ratios with correction of electrolytes [50]. The correction of acid-base derangements is accomplished with adequate resuscitation and not pharmacologic correction (i.e., sodium bicarbonate [51] and vasopressors).…”