Descriptive characteristics and in‐hospital mortality of critically bleeding patients requiring massive transfusion: results from the Australian and New Zealand Massive Transfusion Registry

Ruseckaite, Rasa; McQuilten, Zoe; Oldroyd, John; Richter, Tania H.; Cameron, Peter; Isbister, James P.; Wood, Erica M.

doi:10.1111/vox.12487

Cited by 37 publications

(36 citation statements)

References 47 publications

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“…The treatment of bleeding is to stop the bleeding and to avoid the need for massive transfusion that is associated with high morbidity and mortality [2][3][4][5]. Prophylactic and/or inappropriate plasma and platelet transfusion does not prevent bleeding and transfusion and is associated with worse outcomes including mortality [6][7][8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

The role of evidence-based algorithms for rotational thromboelastometry-guided bleeding management

Görlinger

Pérez-Ferrer

Dirkmann

et al. 2019

Korean J Anesthesiol

165

138

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Rotational thromboelastometry (ROTEM) is a point-of-care viscoelastic method and enables to assess viscoelastic profiles of whole blood in various clinical settings. ROTEM-guided bleeding management has become an essential part of patient blood management (PBM) which is an important concept in improving patient safety. Here, ROTEM testing and hemostatic interventions should be linked by evidence-based, setting-specific algorithms adapted to the specific patient population of the hospitals and the local availability of hemostatic interventions. Accordingly, ROTEM-guided algorithms implement the concept of personalized or precision medicine in perioperative bleeding management ('theranostic' approach). ROTEM-guided PBM has been shown to be effective in reducing bleeding, transfusion requirements, complication rates, and health care costs. Accordingly, several randomized-controlled trials, meta-analyses, and health technology assessments provided evidence that using ROTEM-guided algorithms in bleeding patients resulted in improved patient's safety and outcomes including perioperative morbidity and mortality. However, the implementation of ROTEM in the PBM concept requires adequate technical and interpretation training, education and logistics, as well as interdisciplinary communication and collaboration. Fig. 1. ROTEM trace ('temogram') displaying the clinically most important parameters and their informative value. FDPs: fibrin (ogen) split products. Courtesy of Klaus Görlinger, Germany.

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Section: Introductionmentioning

confidence: 99%

The role of evidence-based algorithms for rotational thromboelastometry-guided bleeding management

Görlinger

Pérez-Ferrer

Dirkmann

et al. 2019

Korean J Anesthesiol

165

138

View full text Add to dashboard Cite

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Section: The Epidemiology Of Massive Transfusionsmentioning

confidence: 99%

“…MT patients are more likely to be male and middle aged, and a majority are non-trauma patients (Halmin et al, 2016;Ruseckaite et al, 2017). Patients undergoing surgery, including cardiothoracic and gastrointestinal (GI) surgery, are the greatest recipients of MTs (Halmin et al, 2016;Ruseckaite et al, 2017). Despite being the focus of most of the research, trauma patients receive <20% of all MTs (Zatta et al, 2014;Halmin et al, 2016;Mesar et al, 2017;Ruseckaite et al, 2017).…”

Section: The Epidemiology Of Massive Transfusionsmentioning

confidence: 99%

“…Patients undergoing surgery, including cardiothoracic and gastrointestinal (GI) surgery, are the greatest recipients of MTs (Halmin et al, 2016;Ruseckaite et al, 2017). Despite being the focus of most of the research, trauma patients receive <20% of all MTs (Zatta et al, 2014;Halmin et al, 2016;Mesar et al, 2017;Ruseckaite et al, 2017). Although hospitals often maintain emergency blood supplies for use in obstetrics, and this drives many inventory management decisions, major post-partum haemorrhage requiring MT is fortunately rare -in the UK, this has been reported to be just 23 cases per 100 000 maternity admissions (Green et al, 2016b), and obstetric patients receive <6% of all MTs (Halmin et al, 2016;Ruseckaite et al, 2017).…”

Section: The Epidemiology Of Massive Transfusionsmentioning

confidence: 99%

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

Flint

McQuilten

Wood

2018

Transfusion Medicine

Self Cite

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Massive transfusion or major haemorrhage protocols have been widely adopted in the treatment of critically bleeding patients. Following evidence that higher ratios of transfused plasma and platelets to red blood cells may offer survival benefits in military trauma patients, these ratios are now commonly incorporated into massive transfusion protocols. They more closely resemble the effects of whole blood transfusion, which in the second half of last century was largely replaced by individual blood component transfusion based on laboratory-guided indicators. However, high-quality evidence to guide transfusion support for critically bleeding patients across the range of bleeding contexts is lacking, including for both trauma and non-trauma patients. More data on major haemorrhage support and clinical outcomes are needed to inform guidelines and practice.

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“…Management of acute GIB has been reported to utilize around 9–21% of all blood products transfused and approximately 14% of massive transfusion (MT) events . A restrictive transfusion strategy for acute upper GIB, a concept spearheaded by Duggan, has gained impetus with growing evidence suggesting this approach reduces risk of rebleeding and mortality ; however, optimal transfusion practice and clinical outcomes remain undefined.…”

Section: Introductionmentioning

confidence: 99%

Clinical coding data algorithm to categorize type of gastrointestinal bleeding as a primary reason for massive transfusion: results from the Australian and New Zealand Massive Transfusion Registry

et al. 2019

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Background Management of major gastrointestinal bleeding (GIB) may require massive transfusion (MT), but limited data are available. Upper and lower GIB have different aetiologies, prognosis, bleeding patterns and outcomes. Better understanding of current transfusion management and outcomes in these patients is important. We sought to define and validate an algorithm based on clinical coding data to distinguish critical upper and lower GIB using data from the Australian and New Zealand Massive Transfusion Registry (ANZ-MTR). Study Design and Methods Australian and New Zealand Massive TransfusionRegistry hospital-source data on adult patients receiving a MT (defined as ≥5 red cell units within 4 h) for any bleeding context were used. An algorithm allocating ICD-10-AM codes into 'probable' or 'possible' causes of GIB was developed and applied to the ANZ-MTR. Source medical records of 69 randomly selected cases were independently reviewed to validate the algorithm. ResultsOf 5482 MT cases available from 25 hospitals, 716 (13%) were identified as GIB with 538/716 (75%) categorized 'probable' and 178/716 'possible' GIB. Upper and lower GIB causes of MT were identified for 455/538 (85%) and 76/538 (14%) 'probable' cases, respectively; 7/538 (1Á3%) cases had both upper and lower GIB. Allocation by the algorithm into a 'probable' GIB category had a 95Á7% (CI: 90-100%) positive predictive value when validated against source medical records.Conclusion An algorithm based on ICD-10-AM codes can be used to accurately categorize patients with luminal GIB as the primary reason for MT, enabling further study of this critically unwell and resource-intensive cohort of patients.

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Descriptive characteristics and in‐hospital mortality of critically bleeding patients requiring massive transfusion: results from the Australian and New Zealand Massive Transfusion Registry

Cited by 37 publications

References 47 publications

The role of evidence-based algorithms for rotational thromboelastometry-guided bleeding management

The role of evidence-based algorithms for rotational thromboelastometry-guided bleeding management

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

Clinical coding data algorithm to categorize type of gastrointestinal bleeding as a primary reason for massive transfusion: results from the Australian and New Zealand Massive Transfusion Registry

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