Protocols for massive blood transfusion: when and why, and potential complications

Guerado, E.; Medina, Ángeles; Mata, María Isabel; Galvan, Jacqueline M.; Bertrand, Maria

doi:10.1007/s00068-015-0612-y

Cited by 57 publications

(54 citation statements)

References 82 publications

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“…The pooled odds ratios for developing an infectious complication and acute respiratory distress syndrome were 1.8 (95% CI, 1.5–2.2) and 2.5 (95% CI, 1.6–3.3), respectively [ 12 ]. While the incidence of massive transfusion is relatively low, patients requiring massive transfusions have a high mortality [ 13 ] and are at risk of developing a variety of complications such as coagulopathy, immunosuppression, hypothermia, and lung injury [ 19 ]. The units of blood transfusion did matter in determining the probability of mortality calculated by the Geriatric Trauma Outcome Score in the trauma elderly.…”

Section: Discussionmentioning

confidence: 99%

Significance of Blood Transfusion Units in Determining the Probability of Mortality among Elderly Trauma Patients Based on the Geriatric Trauma Outcome Scoring System: A Cross-Sectional Analysis Based on Trauma Registered Data

Rau

Kuo

et al. 2018

IJERPH

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Background: For elderly trauma patients, a prognostic tool called the Geriatric Trauma Outcome Score (GTOS), where GTOS = (age) + (ISS × 2.5) + (22 if any packed red blood cells (pRBCs) were transfused within 24 h after admission), was developed for predicting mortality. In such calculation, a score of 22 was added in the calculation of GTOS regardless of the transfused units of blood. This study aimed to assess the effect of transfused blood units on the mortality outcomes of the elderly trauma patients who received blood transfusion (BT). Methods: Detailed data of 687 elderly trauma patients aged ≥65 years who were transfused with pRBCs within 24 h after admission into a level I trauma center between 1 January 2009 and 31 December 2016 were retrieved from the Trauma Registry System database. Based on the units of pRBCs transfused, the study population was divided into two groups to compare the mortality outcomes between these groups. Adjusted odds ratios (AORs) with its 95% confidence intervals (CIs) for mortality were calculated by adjusting sex, pre-existing comorbidities, and GTOS. Results: When the cut-off value of BT was set as 3 U of pRBCs, patients who received BT ≥ 3 U had higher odds of mortality than those who received BT < 3 U (OR, 3.0; 95% CI, 1.94–4.56; p < 0.001). Patients who received more units of pRBCs still showed higher odds of mortality than their counterparts. After adjusting for sex, pre-existing comorbidities, and GTOS, comparison revealed that the patients who received BT of 3 U to 6 U had a 1.7-fold adjusted odds of mortality than their counterparts. The patients who received BT ≥ 8 U and 10 U had a 2.1-fold (AOR, 2.1; 95% CI, 1.09–3.96; p < 0.001) and 4.4-fold (AOR, 4.4; 95% CI, 2.04–9.48; p < 0.001) adjusted odds of mortality than those who received BT < 8 U and <10 U, respectively. Conclusions: This study revealed that the units of BT did matter in determining the probability of mortality. For those who received more units of blood, the mortality may be underestimated according to the GTOS.

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Section: Discussionmentioning

confidence: 99%

Significance of Blood Transfusion Units in Determining the Probability of Mortality among Elderly Trauma Patients Based on the Geriatric Trauma Outcome Scoring System: A Cross-Sectional Analysis Based on Trauma Registered Data

Rau

Kuo

et al. 2018

IJERPH

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“…In addition, blood routine reports can help to dictate further treatments, such as PRBC transfusion, surgical intervention and hemostasis. 32 – 34 …”

Section: Discussionmentioning

confidence: 99%

Effect of team training on efficiency of trauma care in a Chinese hospital

Hong

Cai

2017

J Int Med Res

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ObjectiveMultidisciplinary trauma teams are the standard of care in the USA, but staffing differences and lack of advanced trauma life support training hinder replication of this system in Chinese hospitals. We investigated the effect of simulation team training on initial trauma care.MethodsOver 15 months, we compared grade I trauma patients cared for by the trained team and those cared for using traditional practice on times from emergency room arrival to tests/procedures. Propensity-score analysis was performed to improve between-group comparisons.ResultsDuring the study, 144 grade I trauma patients were treated. Trained team patients showed shorter times from emergency room arrival to initiation of hemostasis (31.0 [13.5–58.5] vs. 113.5 [77–150.50] min), blood routine report (8 [5–10.25] vs. 13 [10–21] min), other blood tests (21 [14.75–25.75] vs. 31 [25–37] min), computed tomography scan (29.5 [20.25–65] vs. 58.5 [30.25–71.25] min) and tranexamic acid administration (31 [13–65] vs. 90 [65–200] min). Similar results were obtained for the propensity-score matched cohort.ConclusionSimulation team training could help reduce time to blood routine reports, scans and hemostasis. Assessment of available resources and development of targeted team training could improve care in resource-limited hospitals.

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“…Although hard evidence for the beneficial effects of pre‐hospital transfusion is lacking, such transfusions should theoretically improve outcomes in selected patients with substantial blood loss. On the other hand, unnecessary transfusion involves unnecessary risks and wastage of resources, in particular, of valuable O negative units. Careful selection of patients is therefore paramount.…”

Section: Discussionmentioning

confidence: 99%

Pre‐hospital transfusion of red blood cells. Part 1: A scoping review of current practice and transfusion triggers

Turenhout

Bossers

Loer

et al. 2020

Transfusion Medicine

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Objectives: The primary aim of this scoping review is to describe the current use of pre-hospital transfusion of red blood cells (PHTRBC) and to evaluate criteria used to initiate PHTRBC. The effects on patients' outcomes will be reviewed in Part 2.Background: Haemorrhage is a preventable cause of death in trauma patients, and transfusion of red blood cells is increasingly used by Emergency Medical Services (EMS) for damage control resuscitation. However, there are no guidelines and little consensus on when to initiate PHTRBC.Methods: PubMed and Web of Science were searched through January 2019; 71 articles were included.Results: Transfusion triggers vary widely and involve vital signs, clinical signs of poor tissue perfusion, point of care measurements and pre-hospital ultrasound imaging. In particular, hypotension (most often defined as systolic blood pressure ≤ 90 mmHg), tachycardia (most often defined as heart rate ≥ 120/min), clinical signs of poor perfusion (eg, prolonged capillary refill time or changes in mental status) and injury type (ie, penetrating wounds) are common pre-hospital transfusion triggers.Conclusions: PHTRBC is increasingly used by Emergency Medical Services, but guidelines on when to initiate transfusion are lacking. We identified the most commonly used transfusion criteria, and these findings may provide the basis for consensus-based pre-hospital transfusion protocols.damage control resuscitation, emergency medical service, major haemorrhage, pre-hospital transfusion, red blood cells, transfusion criteria

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Protocols for massive blood transfusion: when and why, and potential complications

Cited by 57 publications

References 82 publications

Significance of Blood Transfusion Units in Determining the Probability of Mortality among Elderly Trauma Patients Based on the Geriatric Trauma Outcome Scoring System: A Cross-Sectional Analysis Based on Trauma Registered Data

Significance of Blood Transfusion Units in Determining the Probability of Mortality among Elderly Trauma Patients Based on the Geriatric Trauma Outcome Scoring System: A Cross-Sectional Analysis Based on Trauma Registered Data

Effect of team training on efficiency of trauma care in a Chinese hospital

Pre‐hospital transfusion of red blood cells. Part 1: A scoping review of current practice and transfusion triggers

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