Room for (Performance) Improvement: Provider-Related Factors Associated With Poor Outcomes in Massive Transfusion

Cotton, Bryan A.; Dossett, Lesly A.; Au, Brigham K.; Nuñez, Timothy C.; Robertson, Amy; Young, Pampee P.

doi:10.1097/ta.0b013e3181bcb2a8

Cited by 86 publications

(72 citation statements)

References 2 publications

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“…(24) Hence, constant review, optimised resource activation and allocation, and strict compliance to the MTP are necessary to ensure that the transfusion ratios of blood products are closer to the ideal ratio.…”

Section: Discussionmentioning

confidence: 99%

The use of massive transfusion protocol for trauma and non-trauma patients in a civilian setting: what can be done better?

Wijaya

Cheng

Chong

2016

smedj

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INTRODUCTIONMassive transfusion protocol (MTP) is increasingly used in civilian trauma cases to achieve better haemostatic resuscitation in patients requiring massive blood transfusions (MTs), with improved survival outcomes. However, in non-trauma patients, evidence for MTP is lacking. This study aims to assess the outcomes of a newly established MTP in a civilian setting, for both trauma and non-trauma patients, in an acute surgical care unit.METHODS A retrospective cohort analysis was performed on 46 patients for whom MTP was activated in Changi General Hospital, Singapore. The patients were categorised into trauma and non-trauma groups. Assessment of Blood Consumption (ABC) score was used to identify MTP trauma patients and analyse over-activation rates. RESULTSOnly 39.1% of all cases with MTP activation eventually received MTs; 39.8% of the MTs were for non-trauma patients. Mean fresh frozen plasma to packed red blood cells (pRBC) ratio achieved with MTP was 0.741, while mean platelet to pRBC ratio was 0.213. The 24-hour mortality rate for all patients who received an MT upon MTP activation was 33.3% (trauma vs. non-trauma group: 45.5% vs. 14.3%). The ABC scoring system used for trauma patients had a sensitivity and specificity of 81.8% and 41.2%, respectively. CONCLUSION MTP may be used for both trauma and non-trauma patients in acute care surgery. Scoring systems to predict the need for an MT, improved compliance to predefined transfusion ratios and regular reviews of the MTP are necessary to optimise MTPs and to improve the outcomes of patients receiving MTs.

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Section: Discussionmentioning

confidence: 99%

The use of massive transfusion protocol for trauma and non-trauma patients in a civilian setting: what can be done better?

Wijaya

Cheng

Chong

2016

smedj

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“…Massive transfusion is defined as transfusion of more than 10 units of blood within the first 24 h or replacement of one blood volume in a 24 h period [1,2]. In civilian trauma, about 5% of patients undergoes massive transfusion [3,4].…”

Section: Introductionmentioning

confidence: 99%

Compliance with a massive transfusion protocol (MTP) impacts patient outcome

Bawazeer

Ahmed²,

Izadi³

et al. 2015

Injury

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“…When three or more of these triggers were present, the likelihood of MT was increased [ 18 -21 , 52 , 79 ]. Spearheading the way in 2005, Cotton et al implemented an MTP in which predefi ned blood product ratios were transfused at their institution [ 76 ]. Retrospectively, they found early protocol activation and achievement of predefi ned plasma and platelet ratios were independent predictors of survival, while emergency department activation and direct blood bank notifi cation by the trauma attending were associated with a reduction in blood product waste [ 76 ].…”

Section: Massive Transfusion Protocolsmentioning

confidence: 98%