Massive transfusion predictive scores in trauma. Experience of a transfusion registry

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

“…The process becomes even more valuable in the context of multiple casualties where blood component use may need to be prioritised [26]. Some investigators have developed predictive models for massive transfusion to aid clinical decision making [9,10,27,28]. Whilst conceptually attractive, these models have several limitations.…”

Massive Transfusion Protocols

“…Due to the massive resources required to execute an MT, early recognition of patients at risk is critical [ 29 ]. MT is applied in a very small percentage of patients, whose mortality rates range between 40 % and 60 %; these individuals consume large amounts of blood and blood products [ 30 ]. Early and aggressive transfusion with balanced ratios of blood products has become the modern approach and has been shown to correct the three elements of the lethal triad [ 5 , 28 , 31 ].…”

Resuscitative goals and new strategies in severe trauma patient resuscitation

“…42 Therefore, the definition of massive bleeding which we use, and which was described in the 1990s as the need for over 10 red cell concentrate units in under 24 h, does not precisely reflect the way in which transfusions currently should be carried out in severe trauma patients. 35,41,43 The recently published results of the PROMMPT study, which included 1245 patients in 10 trauma centers, indicate a decrease in mortality when the ratios of FFP and platelets versus RC approach 1:1. 26 These data are consistent with those of previous studies which found FFP:RC ratios of under 1:2 to be associated with decreased mortality after trauma.…”

“…A recent study comparing some of these scales has shown the Trauma Associated Severe Hemorrhage Score (TASH) to offer the best correlation, making it possible to identify those patients who do not require activation of the MTP. 43 Table 1 describes the TASH, as well as the probability of massive bleeding according to the score reached. 48 Other parameters may also be predictive of the need to activate the MTP, including the presence of hypocalcemia or the results of the ROTEM.…”