Emergency department staff knowledge of massive transfusion for trauma: the need for an evidence based protocol

Milligan, Craig; Higginson, Ian; Smith, Jessi L.

doi:10.1136/emj.2009.088138

Cited by 17 publications

(8 citation statements)

References 19 publications

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“…6 Our work is also similar to another investigation that concluded emergency physicians lack core knowledge on the use of blood and blood components in the context of major hemorrhage following trauma. 7 Therefore, it would appear that more research into how best to educate staff on the use, value, and interpretation of TEG is required. Unless this is performed, we are unlikely to see TEG results being used to guide blood component transfusion as literature indicates it has the potential to do so.…”

Section: Discussionmentioning

confidence: 99%

The practicalities and barriers of using TEG6s in code red traumas: an observational study in one London major trauma centre

Morton

Galea

Uprichard

et al. 2018

CJEM

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ObjectiveTrauma induced coagulopathy is a disorder of the coagulation pathway that occurs following major trauma. “Code red trauma” require massive hemorrhage protocol activation. The aim was to qualitatively establish the reasons TEG is not currently utilized and the ongoing practicalities in performing a TEG sample for trauma-related massive hemorrhage.MethodsA pilot study was performed using a TEG6s machine within one central London Major Trauma Centre’s resuscitation department. Staff were asked to run a TEG sample on any “code red” patient who attended during the trial. Staff were given questionnaires both before and after the trial to assess the knowledge around TEG.ResultsA TEG sample was performed in 75% of the sixteen “code red traumas,” with one sample being unsuccessful. Only one patient had their blood component management altered due to the TEG result with only 50% of consultants and registrars surveyed feeling confident in interpreting TEG results.ConclusionTEG6s samples can be run within the resuscitation department in a “code red trauma.” However, there is a significant lack of knowledge relating to TEG within the emergency department which is likely to hinder its impact on personalized blood component management. More research is required in how to provide appropriate education in a busy setting to enable TEG to be utilized appropriately.

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Section: Discussionmentioning

confidence: 99%

The practicalities and barriers of using TEG6s in code red traumas: an observational study in one London major trauma centre

Morton

Galea

Uprichard

et al. 2018

CJEM

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“…102 Although clinical trials provide considerable guidance on the utility of blood component ratios, 80 antifibrinolytic agents, 93,94 use of recombinant factor VIIa 84,85 and other areas of management, they fail to provide recommendations on how to construct the protocol, modifications for community hospitals or specific patient populations. 9,12,26 We modified the Delphi exercise to allow for an open forum after round 1 to increase input from experienced practitioners and to discuss the vast quantity of available literature to ensure that all participants had a foundation in MHP knowledge. This allowed for the broadest capture of areas of massive hemorrhage that are logistical in nature and do not lend themselves to evaluation in clinical trials, such as communication strategies and procedures, protocol nomenclature, frequency and type of laboratory testing, laboratory resuscitation targets, and blood component transport and bedside storage.…”

Section: Openmentioning

confidence: 99%

A regional massive hemorrhage protocol developed through a modified Delphi technique

Callum

Petrosoniak²,

McVey³

et al. 2019

cmajo

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assive bleeding is a leading preventable cause of death following trauma, childbirth and surgery. 1-3 There were 5.1 million deaths after traumatic injury worldwide in 2010, mostly affecting young people, accounting for nearly 10% of all deaths. 4 In the United States, it is estimated that up to 20% of such deaths are the direct result of preventable hemorrhage. 4-7 Management of unstable hemorrhagic shock is centred on stabilizing the patient with prompt transfusion of blood components, and rapid identification and treatment of the source of bleeding. Patient outcome is dependent on the availability of rapid definitive surgical intervention, support of a transfusion medicine and clinical laboratory, prompt access to hemostatic agents and care provided by a high-performing interdisciplinary team. 8 In the trauma literature, protocolized delivery of massive transfusion streamlines the complexities

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“…The MHP knowledge must be in the clinician's head as the rapidity of bleeding will prevent reading of a policy in the middle of trying to deliver care. When physicians are surveyed in studies, their knowledge is poor about massive transfusion and often they do not even know of the existence of an MHP at their own institution . A controlled educational process with online education and testing required for annual credentialing is likely to be required to achieve the necessary knowledge base for physician, nurses and technologists.…”

Section: Quality Assurancementioning

confidence: 99%

Massive haemorrhage protocol: what's the best protocol?

Callum

Nascimento

Alam

2016

ISBT Science Series

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Massive transfusion protocols became common practice between 2006 and 2010. The terminology of 'massive transfusion protocol' was improved to 'massive haemorrhage protocol (MHP)' with the astute recognition that at the start of such a protocol, it is unclear which patients will meet the definition of massive transfusion (10 U/24 h). Despite the majority of the literature being reported from the trauma population, hospitals have generally adopted a single MHP for all patients. It remains unclear whether the same protocol can be used for all patients. MHPs assist with the prevention and management of the acute coagulopathy of trauma/shock (ACOTS). The goals of a MHP are to improve haemostasis, communication and patient outcomes. The protocol must be specific for an individual hospital, depending on factors such as prehospital transport times, distance from laboratory to trauma and operating rooms, patient populations served and types of tests available. The key components of a MHP are the 6Ts: triggering of the protocol, laboratory testing, tranexamic acid, temperature maintenance, transfusion support and termination of the protocol when haemostasis is achieved. The evidence and importance of each of these steps will be discussed in detail. It is also critical that a quality assurance programme supports the MHP. Poor compliance with the institutional MHP is associated with inferior survival. Each MHP activation should be followed by a formal debrief by the team. Audits should be performed to determine compliance and to inform annual update of the MHP. Formal training and/or simulation should be a core part of the policy.

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Emergency department staff knowledge of massive transfusion for trauma: the need for an evidence based protocol

Cited by 17 publications

References 19 publications

The practicalities and barriers of using TEG6s in code red traumas: an observational study in one London major trauma centre

The practicalities and barriers of using TEG6s in code red traumas: an observational study in one London major trauma centre

A regional massive hemorrhage protocol developed through a modified Delphi technique

Massive haemorrhage protocol: what's the best protocol?

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