Not only in trauma patients: hospital‐wide implementation of a massive transfusion protocol

Abstract

Objectives To review outcomes of massive transfusion protocol (MTP) activation and determine the impact of MTP implementation on blood bank use. Background MTP has been established to rapidly provide plasma and packed red blood cells in ratios approaching 1:1. Due to availability, MTP has been utilized in non-traumatic hemorrhage despite evidence of benefit in this population. Our hospital wide implementation of MTP was reviewed for propriety, outcomes, and effect on blood bank resources. Methods Retrospective cohort study of patients receiving transfusion after MTP activation from October 2009- 2011. Underlying medical conditions and baseline medication use were determined. In-hospital and 24-hour mortality were compared with evaluation for confounding by APACHE score and duration of MTP activation. Blood product use before and after MTP implementation was reviewed. Results MTP activation occurred in 62 trauma and 63 non-trauma patients. Non-trauma patients were older, had more underlying medical conditions, and higher APACHE scores compared to trauma patients. 24-hour mortality was higher in trauma compared to non-trauma patients (27.4% vs. 11.1%, p =0.02). There was no significant difference of in-hospital mortality. Transfusion ratio did not differ between trauma and non-trauma patients and was not associated with mortality even when MTP activation duration and APACHE score were considered. Hospital-wide blood product use did not change with MTP implementation. Conclusions MTP may be successfully used in trauma and non-trauma settings without significantly impacting overall blood product utilization. Inclusion of non-trauma patients into prospective studies of resuscitation with blood products is warranted to ensure benefit in these patients.

International assessment of massive transfusion protocol contents and indications for activation

“…1 Some benefits of using MTPs in nontrauma bleeding emergencies may include the expedited delivery of blood components and reduced blood component wastage. 13,14 However, availability of MTPs for nontrauma hemorrhage may be more frequently associated with overactivation and concomitant inefficient mobilization of resources. 15,16 The goals of this study were to describe the clinical settings in which MTPs were activated, focusing on 1) how often MTPs are issued to nontrauma patients, 2) in what clinical settings these nontrauma MTPs are issued, and 3) whether and how hospitals adjust contents of their MTPs for nontrauma settings to accommodate potential differences in the pathophysiology of hemorrhage.…”

Changes in plasma unit distributions to hospitals over a 10‐year period

“…At the same time, however, damage control resuscitation of massively bleeding patients emphasizes an early plasma transfusion strategy, often initially in a 1:1 ratio with transfused red blood cells, to address the significant number of trauma patients with early trauma‐induced coagulopathy . Early plasma use has been adopted in massive transfusion protocols (MTPs) for nontrauma recipients as well, although evidence for the efficacy of early plasma transfusion in this patient group is more limited . Having an MTP available usually requires the hospital transfusion service to maintain thawed plasma, usually group AB, for the management of patients of unknown ABO group.…”

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

“…In another retrospective study of both trauma and non‐trauma patients, of 865 patients who received MTs (defined as >10 units of RBCs in 24 h) over 4 years, 767 (88·7%) were classified as non‐trauma, and there was no difference in 30‐day mortality comparing higher ratios to lower ratios (Mesar et al, ). When considering individual non‐trauma subgroups, there was a reduced risk of mortality for higher ratios in the vascular subgroup and a reduced risk of mortality for lower ratios for the medicine and general surgery subgroups (Baumann Kreuziger et al, ). In a retrospective study of 324 cardiac surgery patients receiving MTs, Delaney and colleagues compared those receiving higher ratios of plasma and platelets to RBCs and concluded that higher ratios of both plasma to RBCs and platelets to RBCs were associated with less organ dysfunction, and higher ratios of plasma to RBCs were associated with lower mortality (Delaney et al, ).…”

“…However, few studies have looked at the evidence for higher ratios in non-trauma patients, and prospective data are generally lacking. Baumann Kreuziger et al (2014) conducted a retrospective study of 62 trauma and 63 non-trauma patients and found that transfusion ratio was not associated with mortality for either patient cohort. In another retrospective study of both trauma and non-trauma patients, of 865 patients who received MTs (defined as >10 units of RBCs in 24 h) over 4 years, 767 (88·7%) were classified as non-trauma, and there was no difference in 30-day mortality comparing higher ratios to lower ratios (Mesar et al, 2017).…”