Massive transfusion protocols in nontrauma patients: A systematic review and meta-analysis

Abstract

Background Massive bleeding is a major cause of death both in trauma and non-trauma patients. In trauma patients, the implementation of massive transfusion protocols (MTP) led to improved outcomes. However, the majority of patients with massive bleeding are non-trauma patients. Objectives To assess if the implementation MTP in non-trauma patients with massive bleeding leads to improved survival. Data sources National Library of Medicine's Medline database (PubMed). Study eligibility criteria Original research articles in English language investigating MTP in non-trauma patients. Participants Non-trauma patients with massive bleeding  18 years of age. Intervention Transfusion according to MTP versus off-protocol. Study appraisal and synthesis methods Systematic literature review using PubMed. Outcomes assessed were mortality and transfused blood products. Studies that compared mortality of MTP and non-MTP groups were included in meta-analysis using Mantel-Haenszel random effect models.

Normalization Of Blood Clotting Characteristics Using Prothrombin Complex Concentrate, Fibrinogen And FXIII In An Albumin Based Fluid: Experimental Studies In Thromboelastometry.

“…Massive bleeding, independent of its etiology (trauma, obstetrical or surgical), usually includes high ratio FFP transfusion guided by institutional massive transfusion protocols, based on a large body of evidence favoring plasma against coagulation factor-free resuscitation uids 11,18 . This hemostatic resuscitation concept, however, is insu cient to avoid massive transfusion-associated multifactor coagulopathies 19 .…”

Clinical impact of massive transfusion protocol implementation in non-traumatic patients

“…This result suggests that one should not assume that the transfusion of a high plasma to pRBC ratio will always benefit all patient groups. Recent meta-analysis [16] reported that the non-significant effect of MTP on death rate and delayed MTP activation in nontrauma patients may have affected the result. This delay might result from the unclear actual onset of bleeding in patients with non-traumatic massive hemorrhage.…”

Normalization of Blood Clotting Characteristics Using Prothrombin Complex Concentrate, Fibrinogen and Fxiii In an Albumin Based Fluid: Experimental Studies In Thromboelastometry.

“…Massive bleeding, independent of its etiology (trauma, obstetrical or surgical), usually includes high ratio FFP transfusion guided by institutional MTPs, based on a large body of evidence favoring plasma against coagulation factor-free resuscitation uids 11,18 . This hemostatic resuscitation concept however is insu cient to avoid MT associated multifactor coagulopathies 19 .…”