Use of a Massive Transfusion Protocol in Nontrauma Patients: Activate Away

McDaniel, Lauren M.; Neal, Matthew D.; Sperry, Jason L.; Alarcon, Louis H.; Forsythe, Raquel M.; Triulzi, Darrell J.; Peitzman, Andrew B.; Raval, Jay S.

doi:10.1016/j.jamcollsurg.2013.02.008

Cited by 44 publications

(53 citation statements)

References 10 publications

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“…Although there was no significant difference between the over-activation rates of the trauma and non-trauma groups (60.7% and 61.1%, respectively), the over-activation rate of the non-trauma group was closer to the rates reported in the literature (53.8% and 51% for similar groups of non-trauma patients in studies by McDaniel et al and Morse et al, respectively). (16,17) The MTP over-activation rates reported for trauma patients in the literature are considerably lower than that found in the present study -McDaniel et al (17) reported a 19.2% trauma over-activation rate, while Morse et al (16) reported a 29% trauma over-activation rate.…”

Section: Discussioncontrasting

confidence: 52%

The use of massive transfusion protocol for trauma and non-trauma patients in a civilian setting: what can be done better?

Wijaya

Cheng

Chong

2016

smedj

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INTRODUCTIONMassive transfusion protocol (MTP) is increasingly used in civilian trauma cases to achieve better haemostatic resuscitation in patients requiring massive blood transfusions (MTs), with improved survival outcomes. However, in non-trauma patients, evidence for MTP is lacking. This study aims to assess the outcomes of a newly established MTP in a civilian setting, for both trauma and non-trauma patients, in an acute surgical care unit.METHODS A retrospective cohort analysis was performed on 46 patients for whom MTP was activated in Changi General Hospital, Singapore. The patients were categorised into trauma and non-trauma groups. Assessment of Blood Consumption (ABC) score was used to identify MTP trauma patients and analyse over-activation rates. RESULTSOnly 39.1% of all cases with MTP activation eventually received MTs; 39.8% of the MTs were for non-trauma patients. Mean fresh frozen plasma to packed red blood cells (pRBC) ratio achieved with MTP was 0.741, while mean platelet to pRBC ratio was 0.213. The 24-hour mortality rate for all patients who received an MT upon MTP activation was 33.3% (trauma vs. non-trauma group: 45.5% vs. 14.3%). The ABC scoring system used for trauma patients had a sensitivity and specificity of 81.8% and 41.2%, respectively. CONCLUSION MTP may be used for both trauma and non-trauma patients in acute care surgery. Scoring systems to predict the need for an MT, improved compliance to predefined transfusion ratios and regular reviews of the MTP are necessary to optimise MTPs and to improve the outcomes of patients receiving MTs.

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Section: Discussioncontrasting

confidence: 52%

The use of massive transfusion protocol for trauma and non-trauma patients in a civilian setting: what can be done better?

Wijaya

Cheng

Chong

2016

smedj

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show abstract

“…However, the mean plasma:RBC ratio in this study was only 0.59 (95% CI, 0.51‐0.67), and the ratio was even lower for PLTs. These ratios are similar to those found in an earlier study of traumatically and nontraumatically injured patients on whom an MTP was issued . Perhaps this suggests that the blood products administered to the women in this study were not issued in the context of an MTP where products are often supplied in a 1:1 ratio.…”

Section: Discussionsupporting

confidence: 82%

“…This suggests either that clinicians are overestimating the extent of the hemorrhage and are ordering excessive quantities of RBCs or that unused RBCs that were issued in an MTP are being wasted or returned to the blood bank. In support of the latter explanation, a study of traumatically and nontraumatically injured patients on whom an MTP was issued revealed that less than half of those patients actually received a massive transfusion (defined as receipt of ≥10 units of RBCs in 24 hr) . It remains unclear what a suitable RBC unit “transfusion:return to the blood bank” ratio should be in the setting of obstetric hemorrhage, although it is certainly better that the resuscitation efforts should be overprovided, rather than underprovided, with blood products.…”

Section: Discussionmentioning

confidence: 99%

Blood product transfusion and wastage rates in obstetric hemorrhage

Yazer¹,

Dunbar

Cohn

et al. 2018

Transfusion

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“…[6] The patients of interest, then, are those who “fool us” and go undetected despite this tendency to over-triage. After adjusting for confounders, these false negatives or “missed” MT patients were more often bleeding in the pelvis and had less deviation in their blood pH and base deficits.…”

Section: Discussionmentioning

confidence: 99%

Clinical gestalt and the prediction of massive transfusion after trauma

Pommerening¹,

Goodman²,

Holcomb³

et al. 2015

Injury

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107

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Introduction Early recognition and treatment of trauma patients requiring massive transfusion (MT) has been shown to reduce mortality. While many risk factors predicting MT have been demonstrated, there is no universally accepted method or algorithm to identify these patients. We hypothesized that even among experienced trauma surgeons, the clinical gestalt of identifying patients who will require MT is unreliable. Methods Transfusion and mortality outcomes after trauma were observed at 10 U.S. Level-1 trauma centers in patients who survived ≥30 minutes after admission and received ≥1 unit of RBC within 6 hours of arrival. Subjects who received ≥ 10 units within 24 hours of admission were classified as MT patients. Trauma surgeons were asked the clinical gestalt question “Is the patient likely to be massively transfused?” ten minutes after the patients arrival. The performance of clinical gestalt to predict MT was assessed using chi-square tests and ROC analysis to compare gestalt to previously described scoring systems. Results Of the 1,245 patients enrolled, 966 met inclusion criteria and 221 (23%) patients received MT. 415 (43%) were predicted to have a MT and 551(57%) were predicted to not have MT. Patients predicted to have MT were younger, more often sustained penetrating trauma, had higher ISS scores, higher heart rates, and lower systolic blood pressures (all p < 0.05). Gestalt sensitivity was 65.6% and specificity was 63.8%. PPV and NPV were 34.9% and 86.2% respectively. Conclusion Data from this large multicenter trial demonstrates that predicting the need for MT continues to be a challenge. Because of the increased mortality associated with delayed therapy, a more reliable algorithm is needed to identify and treat these severely injured patients earlier. Level of Evidence II; Diagnostic study - Development of diagnostic criteria on basis of consecutive patients (with universally applied reference standard)

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Use of a Massive Transfusion Protocol in Nontrauma Patients: Activate Away

Cited by 44 publications

References 10 publications

The use of massive transfusion protocol for trauma and non-trauma patients in a civilian setting: what can be done better?

The use of massive transfusion protocol for trauma and non-trauma patients in a civilian setting: what can be done better?

Blood product transfusion and wastage rates in obstetric hemorrhage

Clinical gestalt and the prediction of massive transfusion after trauma

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