MATRA‐A: A study on massive transfusion

Ünlü, Aytekin; Yılmaz, Sercan; Akbasli, Izzet Turkalp; Akyol, Tülay Karaağaç; Akkapulu, Nezih; Tümer, Murat; Örüç, Nigar Ertuğrul; Balas, Şener; Goral, Seniz; Topçuoğlu, Pervin; Tanrıseven, Mustafa; Sayın, Selim; Eryılmaz, Mehmet

doi:10.1111/vox.13082

Cited by 4 publications

(1 citation statement)

References 34 publications

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“…For these patients, massive transfusion, defined as the administration of 10 units or more of packed red cells in a 24-hr period (McQuilten et al, 2021), plays a significant role in resuscitation. Although massive transfusion protocol (MTP) only accounts for 3%–10% of blood products administered, over 90% of patients receiving MTP are trauma patients (American College of Surgeons, 2014; Ünlü et al, 2021) and the mortality rate of patients receiving MTP is approximately 20% (McQuilten et al, 2021).…”

Section: Introductionmentioning

confidence: 99%

Standardized Calcium Replacement in Massive Transfusion: A Quality Improvement Project

Laing,

Burtch,

Storrer

et al. 2023

Journal of Trauma Nursing

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BACKGROUND: Hypocalcemia is common in trauma patients receiving massive transfusion protocol and often leads to worsening coagulopathies. Despite the identified problem and recommendations for replacement, few institutions have implemented a standardized calcium replacement protocol. OBJECTIVE: This study aims to assess whether a revised massive transfusion protocol, including standardized calcium replacement, increases the incidence of calcium administration in trauma patients receiving massive transfusion protocol. METHODS: This quality improvement project used a retrospective pre-/postdesign to study the revision of the current facility's massive transfusion protocol to include calcium replacement and ionized calcium monitoring at an urban Level I academic trauma center. Pre- and postintervention data were collected from January 2022 through October 2022 to determine the number of times massive transfusion protocol was ordered, ionized calcium monitoring, and calcium administration rates. Feedback regarding the protocol was collected throughout the monitoring period and was utilized in the final analysis. RESULTS: A total of 40 patients received massive transfusion protocol, preintervention, 18 of 23 (78%) received calcium supplementation, postintervention, 15 of 16 (98%) were treated. The majority of protocol activations occurred in the trauma bay (79%) and postintervention; ionized calcium monitoring dropped by 14%. CONCLUSION: This study found that the addition of standardized calcium replacement improved administration rates of calcium in this patient population. Ongoing research will ensure the recommended changes improve the identified shortcomings and that patients maintain adequate ionized calcium levels with the current dosing parameters.

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Section: Introductionmentioning

confidence: 99%

Standardized Calcium Replacement in Massive Transfusion: A Quality Improvement Project

Laing,

Burtch,

Storrer

et al. 2023

Journal of Trauma Nursing

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A Descriptive Analysis of Supermassive Transfusion Recipients Among US and Coalition Forces During Combat Operations in Afghanistan and Iraq

Fisher

Lavender²,

April

et al. 2021

Military Medicine

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Introduction Hemorrhage is the leading cause of potentially preventable death on the battlefield. Resuscitation with blood products is essential to restore circulating volume, repay the oxygen debt, and prevent coagulopathy. Massive transfusion (MT) occurs frequently after major trauma; a subset of casualties requires a supermassive transfusion (SMT), and thus, mobilization of additional resources remains unclear. Materials and Methods This is a secondary analysis of a previously described dataset from the Department of Defense Trauma Registry. In this analysis, we isolated U.S. and Coalition casualties that received at least 1 unit of packed red blood cells (PRBCs) or whole blood (WB). Given a lack of consensus on the definition of SMT recipients, we included those patients receiving the top quartile of PRBC and WB administered within the first 24 hours following arrival to a military treatment facility. Results We identified 25,897 adult casualties from January 1, 2007 to March 17, 2020. Within this dataset, 2,608 (9.0%) met inclusion for this analysis. The median number of total products administered within the first 24 hours was 8 units of PRBC or WB. The upper quartile was 18 units (n = 666). Compared to all other blood product recipients, patients in the SMT cohort had a higher median injury severity score (27 vs 18, P < 0.001), were most frequently injured by explosives (84.9% vs 68.6%, P < 0.001), had a higher mean emergency department (ED) pulse (128 vs 111, P < 0.001), a lower mean systolic blood pressure (122 vs 132 mm Hg, P < 0.001), and a higher mean international normalized ratio (1.68 vs 1.38, P < 0.001). SMT patients experienced lower survival to hospital discharge (85.8% vs 93.3%, P < 0.001). Conclusions Compared to all other PRBC and WB recipients, SMT patients experienced more injury by explosives, severe injury patterns, ED vital sign derangements, and mortality. These findings may help identify those casualties who may require earlier aggressive resuscitation. However, more data is needed to define this population early in their clinical course for early identification to facilitate rapid resource mobilization. Identifying casualties who are likely to die within 24 hours compared to those who are likely to survive, may assist in determining a threshold for a SMT.

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Blood component ratios in children with non‐traumatic life‐threatening bleeding

et al. 2022

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Background and Objectives In paediatric trauma patients, there are limited prospective data regarding blood components and mortality, with some literature suggesting decreased mortality with high ratios of plasma and platelets to red blood cells (RBCs) in massive transfusions; however, most paediatric massive transfusions occur for non‐traumatic aetiologies and few studies assess blood product ratios in these children. This study's objective was to evaluate whether high blood product ratios or low deficits conferred a survival benefit in children with non‐traumatic life‐threatening bleeding. Materials and Methods This is a secondary analysis of the five‐year, multicentre, prospective, observational massive transfusion epidemiology and outcomes in children study of children with life‐threatening bleeding from US, Canadian and Italian medical centres. Primary interventions were plasma:RBC and platelets:RBC (high ratio ≥1:2 ml/kg) and plasma and platelet deficits. The primary outcome was mortality at 6 h, 24 h and 28 days. Multivariate logistic regression models were used to determine independent associations with mortality. Results A total of 222 children were included from 24 medical centres: 145 children (median [interquartile range] age 2.1 years [0.3–11.8]) with operative bleeding and 77 (8.0 years [1.2–14.7]) with medical bleeding. In adjusted analyses, neither blood product ratios nor deficits were associated with mortality at 6 h, 24 h or 28 days. Conclusion This paper addresses a lack of prospective data in children regarding optimal empiric massive transfusion strategies in non‐traumatic massive haemorrhage and in finding no decrease in mortality with high plasma or platelet to RBC ratios or lower deficits supports an exploratory analysis for mortality.

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MATRA‐A: A study on massive transfusion

Cited by 4 publications

References 34 publications

Standardized Calcium Replacement in Massive Transfusion: A Quality Improvement Project

Standardized Calcium Replacement in Massive Transfusion: A Quality Improvement Project

A Descriptive Analysis of Supermassive Transfusion Recipients Among US and Coalition Forces During Combat Operations in Afghanistan and Iraq

Blood component ratios in children with non‐traumatic life‐threatening bleeding

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