State of the art: massive transfusion

Abstract

The aim of this article was to review recent developments in the resuscitation of both trauma and non-trauma patients in haemorrhagic shock. Strategies for the resuscitation of massively haemorrhaging patients and the use of massive transfusion protocols (MTPs) have been a major focus of the trauma literature over the past several years. The application of haemostatic resuscitation practices and MTPs to non-trauma populations has long been in practice, but has only recently been the subject of active research. Medline and PubMed were reviewed for 'massive transfusion' (MT) from 2012 to present. Non-English and paediatric articles were excluded. Articles were systematically reviewed for their relevance to MT. There were eight major areas of development identified. In recent MT literature, there was an increased focus on massively haemorrhaging non-trauma patients, the role of acute traumatic coagulopathy, the use of thromboelastography (TEG), and the impact of MTPs on blood product waste and efficiency of product delivery. Other developments included additional MT prediction tools and The PRospective Observational Multicenter Major Trauma Transfusion (PROMMTT) study. There was also interest in re-evaluating the clinical relevance of the current MT definition and identifying new foci for MT. These recent developments reflect efforts to better understand and manage non-traumatic haemorrhage and to address prior limitations in the trauma literature. Inevitably, new questions have been raised, which will likely direct ongoing and future research in MT.

Taking the Blood Bank to the Field: The Design and Rationale of the Prehospital Air Medical Plasma (PAMPer) Trial

“…2,19–21 Evidence suggests that 25% of severely injured patients are coagulopathic at admission, independent of hemodilution. 22,23 Further evidence demonstrates coagulopathy develops within minutes of injury. Patients that develop TIC consistently have worse outcomes, with documented increases in morbidity and mortality.…”

Epidemiology of Massive Transfusion

“…In recent years, protocols for massive transfusion have gained increasing attention, especially with regard to the use of plasma and platelets for trauma-related massive hemorrhage (7). At the same time, possible risks associated with massive transfusion have been discussed and associations with both increased morbidity and mortality have been observed (8).…”

“…This is commonly defined as receipt of 10 or more red cell products during a 24-hour period (3), but a variety of definitions have been applied in studies, and the relevance of the different definitions has been questioned (4)(5)(6). In particular, the risk of introducing a selection bias, by not including patients who exsanguinate early after admission to hospital and who would, therefore, not survive long enough to receive the arbitrary number of sufficient transfusion to fulfill the definition, has been highlighted (7).…”

Haemangioma, Thrombocytopenia and Coagulopathy- Kasabach Merritt Syndrome: An Appraisal for Anaesthesiologists

“…KMS is a rare clinical manifestation in patients with haemangioma, moreover its clinical features are diverse [1][2][3][4][5][6][7]. Although this particular case did not pose much challenge in the perioperative period, this discussion should serve to remind anesthesiologists of the possible complications and management issues that may be encountered with KMS.…”

“…Recently, survival benefit has been documented in patients with traumatic hemorrhage that were managed with hemostatic therapy guided by viscoelastic point-of-care coagulation devices (thromboelastography) [6]. Thromboelastography is also increasingly being used in hemorrhage of non-traumatic origin [7]. In a patient with KMS, FloTrac/Vigileo system was used successfully to guide appropriate resuscitative measures that ensured stable perioperative hemodynamics [5].…”