Step by step transfusion timeline and its challenges in trauma: A retrospective study in a level one trauma center

Abstract

Background Hemorrhagic shock is the leading cause of preventable early death in trauma patients. Transfusion management is guided by international guidelines promoting early and aggressive transfusion strategies. This study aimed to describe transfusion timelines in a trauma center and to identify key points to performing early and efficient transfusions. Methods This is a monocentric retrospective study of 108 severe trauma patients, transfused within the first 48 h and hospitalized in an intensive care unit between January 2017 and May 2019. RESULTS One hundred and eight patients were transfused with 1250 labile blood products. Half of these labile blood products were transfused within 3 h of admission and consumed by 26 patients requiring massive transfusion (≥4 red blood cells [RBC] within 1 h). Among these, the median delay from patient's admission to labile blood products prescription was −11 min (−34 to −1); from admission to delivery of labile blood products was 1 min (−20 to 16); and from admission to first transfusion was 20 min (7–37) for RBC, 26 min (13–38) for plasma, and 72 min (51–103) for platelet concentrates. The anticipated prescription of labile blood products and the use of massive transfusion packs and lyophilized plasma units were associated with earlier achievement of high transfusion ratios. Conclusion This study provides detailed data on the transfusion timelines and composition, from prescription to initial transfusion. Transfusion anticipation, use of preconditioned transfusion packs including platelets, and lyophilized plasma allow rapid and high‐ratio transfusion practices in severe trauma patients.

Study of the Relationship Between Liver Function Markers and Traumatic Rhabdomyolysis: A Retrospective Study of Hemorrhagic Patients Admitted to Intensive Care Unit in a Level I Trauma Center

“…4,37 Patients with intense RM had more transfusion requirements at 24 hours, which was possibly related to the higher severity of their trauma or to more severe coagulopathy. 17 Mortality in our cohort was consistent with the mortality typically seen in severe hemorrhagic trauma. 17,38 There was no significant difference between early and late mortality at different levels of RM, which is consistent with the literature.…”

“…www.anesthesia-analgesia.org 845 years old, and almost 75% of the patients were male. Patients were severely injured, with a median ISS of 26 (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35). RM was highly prevalent in the global cohort (58.1%), and 55 (23.2%) patients presented with intense RM.…”

“…Indeed, factor concentrates are not included in the transfusion protocol of trauma patients in our hospital, and no patient received factor concentrate. 17 In addition, very few patients were receiving anticoagulant therapy at admission, and their distribution was not significantly different between groups (Table 3).…”

“…4,37 Patients with intense RM had more transfusion requirements at 24 hours, which was possibly related to the higher severity of their trauma or to more severe coagulopathy. 17…”

“…14,15 Regarding transfusion management, whenever possible, LBPs were ordered in advance using the Red Flags score. 16,17 In accordance with French recommendations, transfusion was initiated on arrival of the patient in case of hemorrhagic trauma with hemodynamic instability. Otherwise, the threshold observed for red blood cell (RBC) transfusion was a hemoglobinemia >7 g/dL for most patients and >10 g/dL for those with traumatic brain injury.…”