The confusion continues: results from an American Association for the Surgery of Trauma survey on massive transfusion practices among United States trauma centers

Abstract

BACKGROUND:Massive transfusion practices have undergone several recent developments. We sought to examine institutional practices guiding hemostatic resuscitation in the setting of massive hemorrhage. STUDY DESIGN AND METHODS:A 37-question online survey was sent to American Association for the Surgery of Trauma members. RESULTS:A total of 191 surgeons from 125 institutions completed the survey. Level I and II centers composed 70 and 18% of responding sites, respectively. A total of 123 institutions have a massive transfusion protocol (MTP); 54% report having an MTP for less than 5 years. The number of coolers and units of red blood cells, plasma, and platelets are highly variable. Tranexamic acid is part of the MTP at 64% of centers; 26% continue to use recombinant activated Factor VII. MTP activation occurs more than five times per month at 32% of centers. MTPs are utilized for nontrauma patients in 82% of institutions. Point-of-care prothrombin time, international normalized ratio, and partial thromboplastin time testing is utilized in 37% of institutions. Only 9% routinely utilize thromboelastography or rotational thromboelastometry (TEG/ROTEM) within their MTP. Just 7% use a validated scoring system to guide MTP activation. The incorporation of TEG/ROTEM into the MTP is associated with the use of a scoring system in regression analysis (p 5 0.024). CONCLUSION: Most institutions regularly activaterecently implemented MTPs for trauma and nontrauma indications; however, few use validated scoring systems for MTP activation. MTP content is highly variable. Few institutions use TEG, while most have incorporated tranexamic acid into their protocol. The lack of consistent practices underscores the need for outcome-based studies to guide transfusion practices. M assive transfusion strategies have gone through significant changes over the past several years, highlighted by the massive transfusion protocol (MTP), 1,2 which was created as a standardized tool to guide the principles of damage control resuscitation. [3][4][5][6] The development and evolution of the MTP have been driven by the clinical goals of delivering predetermined blood product component ratios and adjuncts in an early, rapid, and coordinated manner to treat severe hemorrhage. 4,7,8 Early, appropriate activation of the MTP results in quicker, more appropriate product delivery, reduced mortality, decreased transfusionrelated complications, and more efficient and cost-effective Whether the confusion identified in prior MTP practice assessments has resolved, and whether evidence-based guidelines have been implemented is unknown. While a recently published survey examined the incorporation of damage control resuscitation practices among institutions participating in TQIP, MTP practice and utilization beyond adherence to TQIP guidelines have not been explored. 24 We sought to examine current trends in massive transfusion practices and MTP composition, activation, and utilization among US trauma centers. We hypothesized that the practices guiding massive he...

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Viscoelastic haemostatic assays and fibrinogen in paediatric acute traumatic coagulopathy: A comprehensive review

“…Despite this, uptake into routine clinical practice has been slow. An audit from adult practice revealed only 9–18% of sites routinely incorporated VHA into their MHP . A similar audit of paediatric practice revealed that in the institutions that had access to VHA they were used to guide management in less than 50% of cases .…”

“…An audit from adult practice revealed only 9-18% of sites routinely incorporated VHA into their MHP. 24 A similar audit of paediatric practice revealed that in the institutions that had access to VHA they were used to guide management in less than 50% of cases. 25 Part of the reason for slower integration is the concern around validation of VHA use in paediatric trauma management, and clinician familiarity and confidence with their interpretation.…”

Damage Control Resuscitation

“…Beyond the initial assessment of the patient, transfusion strategies can differ widely. Most hospitals have adopted massivetransfusion(MTP) protocols (48,49), but variation remains between the ratios of RBCs to FFP administered.…”