Massive transfusion protocol in adult trauma population

Meneses, Evander; Boneva, Dessy; McKenney, Mark; Elkbuli, Adel

doi:10.1016/j.ajem.2020.07.041

Cited by 60 publications

(43 citation statements)

References 51 publications

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“…Backward elimination was used to remove predictors until all remaining predictors had p < 0.05. All analyses were conducted using a commercially available software 1,2 .…”

Section: Discussionmentioning

confidence: 99%

“…Critical bleeding, also termed massive hemorrhage or exsanguination, is a major cause of mortality and morbidity in humans and animals (1,2). Although there is no universal definition of critical bleeding in people, it has been defined as (1) blood loss exceeding circulating blood volume within a 24-h period or (2) blood loss of 50% of circulating blood volume within a 3-h period (3). There is no established veterinary definition for critical bleeding.…”

Section: Introductionmentioning

confidence: 99%

“…There is no established veterinary definition for critical bleeding. In people, the principles of treatment for critical bleeding involve early intervention, including hemostatic resuscitation with blood products, damage control surgery, and administration of anti-fibrinolytic agents, among other interventions ( 1 , 4 ). However, there is a paucity of literature in veterinary medicine regarding critical bleeding.…”

Section: Introductionmentioning

confidence: 99%

“…The primary treatment for exsanguination in both human and veterinary medicine is the transfusion of fresh whole blood (FWB) or a combination of blood components, such as pRBCs and/or fresh frozen plasma (FFP) ( 5 , 6 ). Recent literature reviews in people on MTPs suggest that the administration of plasma to pRBCs should be in a ratio of 1:1 or 1:2, something that that has not yet been explored in veterinary medicine ( 1 , 9 ). Veterinary studies investigating data related to when to trigger MTP, how to implement resuscitation of dogs with critical bleeding (including the type of blood products, amount of product give, pRBC/FFP ratio, and ratio of non-blood product resuscitation fluids to blood products), and dosing and timing of additional therapies such as fibrinolytic inhibitors have not yet been performed.…”

Section: Introductionmentioning

confidence: 99%

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Resuscitation Patterns and Massive Transfusion for the Critical Bleeding Dog—A Multicentric Retrospective Study of 69 Cases (2007–2013)

et al. 2022

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Objective: To describe resuscitation patterns of critically bleeding dogs, including those receiving massive transfusion (MT).Design: Retrospective study from three universities (2007–2013).Animals: Critically bleeding dogs, defined as dogs who received ≥ 25 ml/kg of blood products for treatment of hemorrhagic shock caused by blood loss.Measurements and Main Results: Sixty-nine dogs were included. Sources of critical bleeding were trauma (26.1%), intra/perioperative surgical period (26.1%), miscellaneous (24.6%), and spontaneous hemoabdomen (23.1%). Median (range) age was 7 years (0.5–18). Median body weight was 20 kg (2.6–57). Median pre-transfusion hematocrit, total protein, systolic blood pressure, and lactate were 25% (10–63), 4.1 g/dl (2–7.1), 80 mm Hg (20–181), and 6.4 mmol/L (1.1–18.2), respectively. Median blood product volume administered was 44 ml/kg (25–137.4). Median plasma to red blood cell ratio was 0.8 (0–4), and median non-blood product resuscitation fluid to blood product ratio was 0.5 (0–3.6). MT was given to 47.8% of dogs. Survival rate was 40.6%. The estimated odds of survival were higher by a factor of 1.8 (95% CI: 1.174, 3.094) for a dog with 1 g/dl higher total protein above reference interval and were lower by a factor of 0.6 (95% CI: 0.340, 0.915) per 100% prolongation of partial thromboplastin time above the reference interval. No predictors of MT were identified.Conclusions: Critical bleeding in dogs was associated with a wide range of resuscitation patterns and carries a guarded to poor prognosis.

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“…Backward elimination was used to remove predictors until all remaining predictors had p < 0.05. All analyses were conducted using a commercially available software 1,2 .…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Resuscitation Patterns and Massive Transfusion for the Critical Bleeding Dog—A Multicentric Retrospective Study of 69 Cases (2007–2013)

et al. 2022

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“…Hemostatic dysfunction is known to be directly correlated to the level of acidosis [8]. It is understood that enzymes and proteins operate optimally at specific, defined margins of temperature and pH.…”

Section: Discussionmentioning

confidence: 99%

A Case of Aggressive Resuscitation and Timely Surgical Intervention to Reverse Severe Acidosis After Multiple Gunshot Wounds to the Chest, Abdomen, and Left Shoulder With a Bullet Fragment Retained in the Heart

Rosenberger¹,

Lo²,

Hinika³

et al. 2021

Cureus

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The lethal triad of coagulopathy, hypothermia, and acidosis is a well-known cause of severe deterioration and poor prognosis in trauma patients. The presence of this triad complicates the surgical management of a patient suffering from penetrating injury and hemorrhage. Here, we report the case and management of a 44-year-old man with multiple high-caliber gunshot wound (GSW) injuries who became severely acidotic (pH <6.8) with hemorrhagic shock in the setting of massive hemorrhage due to penetrating chest and abdominal trauma. The patient sustained one high-caliber GSW to the left upper quadrant of the abdomen, one highcaliber GSW to the left periumbilical region of the abdomen, one high caliber GSW to the fourth intercostal space of the left chest just medial to the midclavicular line with an expanding hematoma, and one highcaliber GSW to the left shoulder with a floating left shoulder. He arrived at the Emergency Department conscious with a stable pulse but quickly became hemodynamically unstable. He required a thoracotomy and exploratory laparotomy in addition to a massive transfusion protocol. This case demonstrates the reversal of a severely acidotic patient due to massive hemorrhage to a blood pH within normal limits using damage control resuscitation surgery and massive transfusion protocols. The patient has since been discharged home in a stable condition with minimal long-term sequelae.

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High Fresh Frozen Plasma to Red Blood Cell Ratio and Survival Outcomes in Blunt Trauma

Fujiwara,

Okada,

Ishii

et al. 2024

JAMA Surg

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ImportanceCurrent trauma-care protocols advocate early administration of fresh frozen plasma (FFP) in a ratio close to 1:1 with red blood cells (RBCs) to manage trauma-induced coagulopathy in patients with severe blunt trauma. However, the benefits of a higher FFP to RBC ratio have not yet been established.ObjectiveTo investigate the effectiveness of a high FFP to RBC transfusion ratio in the treatment of severe blunt trauma and explore the nonlinear relationship between the ratio of blood products used and patient outcomes.Design, Setting, and ParticipantsThis was a multicenter cohort study retrospectively analyzing data from the Japan Trauma Data Bank, including adult patients with severe blunt trauma without severe head injury (Injury Severity Score ≥16 and head Abbreviated Injury Scale &lt;3) between 2019 and 2022.ExposuresPatients were categorized into 2 groups based on the ratio of FFP to RBC: the high-FFP group (ratio &gt;1) and the low-FFP group (ratio ≤1).Main Outcomes and MeasuresAll-cause in-hospital mortality was the primary outcome. Additionally, the occurrence of transfusion-related adverse events was evaluated.ResultsAmong the 1954 patients (median [IQR] age, 61 [41-77] years; 1243 male [63.6%]) analyzed, 976 (49.9%) had a high FFP to RBC ratio. Results from logistic regression, weighted by inverse probability treatment weighting, demonstrated an association between the group with a high-FFP ratio and lower in-hospital mortality (odds ratio, 0.73; 95% CI, 0.56-0.93) compared with a low-FFP ratio. Nonlinear trends were noted, suggesting a potential ceiling effect on transfusion benefits.Conclusions and RelevanceIn this cohort study, a high FFP to RBC ratio was associated with favorable survival in patients with severe blunt trauma. These outcomes highlight the importance of revising the current transfusion protocols to incorporate a high FFP to RBC ratio, warranting further research on optimal patient treatment.

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Massive transfusion protocol in adult trauma population

Cited by 60 publications

References 51 publications

Resuscitation Patterns and Massive Transfusion for the Critical Bleeding Dog—A Multicentric Retrospective Study of 69 Cases (2007–2013)

Resuscitation Patterns and Massive Transfusion for the Critical Bleeding Dog—A Multicentric Retrospective Study of 69 Cases (2007–2013)

A Case of Aggressive Resuscitation and Timely Surgical Intervention to Reverse Severe Acidosis After Multiple Gunshot Wounds to the Chest, Abdomen, and Left Shoulder With a Bullet Fragment Retained in the Heart

High Fresh Frozen Plasma to Red Blood Cell Ratio and Survival Outcomes in Blunt Trauma

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