Quality management of a massive transfusion protocol

Hess, John R.; Ramos, Patrick J; Sen, Nina; Cruz-Cody, Virginia G; Tuott, Erin E; Louzon, Max J; Bulger, Eileen M.; Arbabi, Saman; Pagano, Monica B.; Metcalf, Ryan A.

doi:10.1111/trf.14443

Cited by 37 publications

(39 citation statements)

References 15 publications

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“…On the other hand, coagulopathy due to gastrointestinal hemorrhage was not observed. Although many facilities use massive transfusion protocols for early replacement of coagulation factors in cases other than trauma [35,36], the results of this study suggest that administration of a high ratio of FFP to RBCs for gastrointestinal bleeding may not be effective. Many reports have described restriction of blood transfusion as showing better prognosis for gastrointestinal bleeding [37][38][39].…”

Section: Discussionmentioning

confidence: 80%

Coagulopathy and damage control resuscitation during transfer due to massive hemorrhage –a single-center retrospective study–

Takahashi¹,

Shoko²,

Kojima³

et al. 2020

Preprint

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Background: To assess medical procedures, particularly damage control resuscitation, at the time of transfer between hospitals for the purpose of treating massive hemorrhage.Methods: This study used a single-center retrospective observational design, enrolling patients referred to Teine Keijinkai Hospital from another hospital between April 2012 and March 2019 for the treatment of massive hemorrhage. We excluded patients who entered cardiac arrest before arriving at our center. Qualitative or categorical variables were compared using the χ2 or Fisher’s exact test, as appropriate. Quantitative continuous variables were compared using Mann-Whitney nonparametric tests, as appropriate. Risk factors associated with coagulopathy from univariate analyses (fibrinogen level £150 mg/dl; prothrombin time-international normalized ratio ³1.5) were entered into stepwise logistic regression analysis. Significance was defined for values of p < 0.05.Results: Multiple logistic regression analysis revealed trauma (odds ratio (OR) 4.800; 95% confidence interval (CI) 2.016–11.433; p < 0.001) and volume of crystalloid solution (OR 1.001; 95%CI 1.000–1.001; p = 0.008) as independent factors associated with coagulopathy. Patients with coagulopathy showed higher 24-h mortality rates (10.9%) than patients without coagulopathy (1.2%; p = 0.021), and cause of death was hemorrhagic shock for all cases of death within 24 h.Conclusion: In our area, withholding intravenous fluid to achieve permissive hypotension, early administration of fresh frozen plasma, and use of fibrinogen concentrate may improve the prognosis of patients with massive hemorrhage undergoing transfer between hospitals.Trial registration: UMIN, UMIN000041201. Registered 24 July 2020 – Retrospectively registered, https://upload.umin.ac.jp/cgi-open-bin/icdr_e/ctr_view.cgi?recptno=R000047048

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Section: Discussionmentioning

confidence: 80%

Coagulopathy and damage control resuscitation during transfer due to massive hemorrhage –a single-center retrospective study–

Takahashi¹,

Shoko²,

Kojima³

et al. 2020

Preprint

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“…Maximum trauma hospital transfusion service blood component issue rates were estimated from local experience with hypermassive transfusions and a local disaster . In one hypermassive transfusion episode a young woman in a motor vehicle collision received 90 units of red blood cells (RBCs) and 80 units of plasma in 3 hours along with platelets and cryoprecipitate pools without delays in service, a rate of 62 components/hr or one component a minute for 3 hours.…”

Section: Methodsmentioning

confidence: 99%

“…Maximum trauma hospital transfusion service blood component issue rates were estimated from local experience with hypermassive transfusions and a local disaster. [4][5][6] In one hypermassive transfusion episode a young woman in a motor vehicle collision received 90 units of red blood cells (RBCs) and 80 units of plasma in 3 hours along with platelets and cryoprecipitate pools without delays in service, a rate of 62 components/hr or one component a minute for 3 hours. In a second hypermassive episode, a young man who sustained multiple gunshot wounds received 202 blood components in 6 hours, a rate of 34 components/hr, higher in some individual hour periods, but the transfusion service noted a degradation of response over time because of the need to provide blood for other patients and divert workers to backfilling inventory to keep from running out completely.…”

Section: Methodsmentioning

confidence: 99%

Cascadia Rising: thoughts on a Seattle earthquake disaster exercise

Hess

2018

Transfusion

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BACKGROUND The Cascadia subduction zone off the US Pacific Northwest coast produces a Force 9 earthquake once every 300 years. Cascadia Rising was a regional disaster drill modeled on such an event. Western Washington State has 5 million people and one Level I trauma center. STUDY DESIGN AND METHODS The blood response of the trauma center and region were modeled under the conditions laid down in the disaster scenario. The scenario assumed structural damage to the 1931 reinforced concrete building housing the trauma hospital transfusion service with loss of electricity, data services, and water. The regional blood center, in a newer building located six blocks away, suffered less disruption. The regional blood inventory is in a blood component manufacturing facility 18 miles south of downtown. RESULTS At best and at risk to life, the trauma center could issue universally compatible components at a rate of 60 components/hr from a damaged but still accessible transfusion service. Usable inventory would be expended in 4 hours with no clear mechanism and rules for resupply. The regional center has additional group O red blood cells and AB or A plasma to sustain that rate of usage for several more hours but no protocols for reestablishing communication or “push” resupply. Regional resources will be gone in less than a day. CONCLUSIONS After a major Cascadia earthquake, blood resources may fail immediately, but even with luck, local resources used emergently at maximal issue rates will last 4 to 14 hours.© 2018 AABB

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“…MTP refers to a transfusion strategy where packed red blood cells, platelets, and fresh frozen plasma are administered in a 1:1:1 ratio. 3 Tranexamic acid should also be administered to patients with massive hemorrhage. 4 Ultimately, the primary goal in Class III and IV hemorrhage is to obtain hemostasis, either surgically or through vascular embolization.…”

Section: Approach To a Bleeding Patientmentioning

confidence: 99%

Clinical Approach to and Work-up of Bleeding Patients

Warhadapande

Dariushnia

Kokabi

et al. 2020

Semin intervent Radiol

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A bleeding patient is a common consult for interventional radiologists. Prompt triage, preprocedural evaluation specific to the site of hemorrhage, and knowledge of resuscitative strategies allow for a potentially life-saving procedure to be appropriately and safely performed. Having a firm understanding of the clinical work-up and management of a bleeding patient has never been more important. In this article, a discussion of the clinical approach and work-up of a bleeding patient for whom interventional radiology is consulted is followed by a discussion of etiology-specific preprocedural work-up.

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Quality management of a massive transfusion protocol

Cited by 37 publications

References 15 publications

Coagulopathy and damage control resuscitation during transfer due to massive hemorrhage –a single-center retrospective study–

Coagulopathy and damage control resuscitation during transfer due to massive hemorrhage –a single-center retrospective study–

Cascadia Rising: thoughts on a Seattle earthquake disaster exercise

Clinical Approach to and Work-up of Bleeding Patients

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