The haemostasis traffic light: a pragmatic tool for bleeding management

Mileo, Federico G.; Kataife, Ezequiel D.; Adrover, Antoni Obrador; Fornari, Gustavo García; López, Marina Sol; Martinuzzo, Marta

doi:10.1111/anae.14874

Cited by 6 publications

(6 citation statements)

References 8 publications

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“…La reposición de fibrinógeno, independientemente de la fuente que se utilice, debiera guiarse por metas para obtener resultados óptimos y consistentes 21,22 . La rápida capacidad de determinar la dosis adecuada de fibrinógeno para optimizar la polimerización de fibrina en estos pacientes mediante tromboelastometría está bien documentada [37][38][39] .…”

Section: Discussionunclassified

Uso de Concentrados de Fibrinógeno para el Tratamiento de la Hipofibrinogenemia Adquirida

et al. 2021

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Introducción: Un adecuado manejo del sangrado debe incluir la correcta valoración y eventual reposición de fibrinógeno. Las fuentes tradicionales de este elemento hemostático incluyen el plasma fresco congelado y los crioprecipitados. Los concentrados liofilizados de fibrinógeno humano (CFH) son una alternativa terapéutica novedosa en el mercado chileno. Este estudio describe el curso clínico de los primeros pacientes en nuestra institución requirentes de CFH, dentro de un algoritmo de reposición hemostática por metas.Método: Serie de pacientes con hipofibrinogenemia secundaria a sangrado perioperatorio severo, en los que se utilizó CFH como método de reposición de fibrinógeno. Se utilizó tromboelastometría para definir dosis. Se registraron variables demográficas, operatorias, complicaciones y seguimiento hasta los 3 meses.Resultados: Se utilizaron CFH en 18 pacientes. La mediana de edad fue 40,7(56,5 – 63) años y dos tercios de los pacientes fueron de sexo masculino. Fallecieron 5 pacientes de la serie. Todos los pacientes requirieron manejo postoperatorio en una unidad de cuidados intensivos. Ocho pacientes fueron sometidos a cirugía cardiaca. El uso de hemocomponentes y concentrados liofilizados fue heterogéneo, pero en todos los casos su uso fue determinado por tromboelastometría. Ningún paciente fue re-intervenido a causa de sangrado postoperatorio.Conclusión: El uso de concentrados de fibrinógeno humano dentro de un algoritmo de manejo de sangrado guiado por tromboelastometría, es un recurso hemostático factible en la realidad nacional. El impacto clínico de esta intervención requiere una subsiguiente evaluación basada en la evidencia.

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Section: Discussionunclassified

Uso de Concentrados de Fibrinógeno para el Tratamiento de la Hipofibrinogenemia Adquirida

et al. 2021

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“…Mileo and colleagues co-designed a hemostasis "traffic light" cognitive tool to guide the initial assessment and management of critical bleeding based on the severity of the bleeding; however, the authors did not elaborate on the particulars of the co-design process. 30 A subsequent randomized simulation trial of this tool demonstrated that for the management of simulated bleeding scenarios, the Hemostasis Traffic Light tool, when compared to text-based guidance, allowed anesthesia providers to solve text-based scenarios more successfully and efficiently. 25 This study, however, did not have participants use both interventions and did not attempt to simulate environmental stressors, which may have significantly affected (or influenced) the outcome.…”

Section: Cds For Mt and Non-mtmentioning

confidence: 99%

Multicenter, multidisciplinary user‐centered design of a clinical decision‐support and simulation system for massive transfusion

et al. 2023

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Background: Managing critical bleeding with massive transfusion (MT) requires a multidisciplinary team, often physically separated, to perform several simultaneous tasks at short notice. This places a significant cognitive load on team members, who must maintain situational awareness in rapidly changing scenarios.Similar resuscitation scenarios have benefited from the use of clinical decision support (CDS) tools. Study Design and Methods: A multicenter, multidisciplinary, user-centered design (UCD) study was conducted to design a computerized CDS for MT. This study included analysis of the problem context with a cognitive walkthrough, development of a user requirement statement, and co-design with users of prototypes for testing. The final prototype was evaluated using qualitative assessment and the System Usability Scale (SUS).Results: Eighteen participants were recruited across four institutions. The first UCD cycle resulted in the development of four prototype interfaces that addressed the user requirements and context of implementation. Of these, the preferred interface was further developed in the second UCD cycle to create a high-fidelity web-based CDS for MT. This prototype was evaluated by 15 participants using a simulated bleeding scenario and demonstrated an average SUS of 69.3 (above average, SD 16) and a clear interface with easy-to-follow blood product tracking.Discussion: We used a UCD process to explore a highly complex clinical scenario and develop a prototype CDS for MT that incorporates distributive situational awareness, supports multiple user roles, and allows simulated MT training. Evaluation of the impact of this prototype on the efficacy and efficiency of managing MT is currently underway.

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“…Multiple CDS tools have been developed for transfusion decision-making with most applying only to nonemergent bleeding transfusion support. 10,[23][24][25] Schmulevich and colleagues developed a CDS for Damage Control Resuscitation, a management approach to major hemorrhage that encompasses MT and damage control surgery, using an iterative human factors focused development approach that involved evaluation in both simulated and clinical environments. 10 This tool, Blood Navigator (Arcos Medical, Texas, USA), utilizes a number of similar features to MTP Assistant, including blood transfusion tally and ratios, TEG interpretation, integrated protocol, and adjunct administration documentation, and operates via a portable tablet device.…”

Section: Comparison To Similar Mt Cds Toolsmentioning

confidence: 99%

Clinical decision support versus a paper‐based protocol for massive transfusion: Impact on decision outcomes in a simulation study

Sanderson,

Field,

Kocaballi

et al. 2023

Transfusion

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BackgroundManagement of major hemorrhage frequently requires massive transfusion (MT) support, which should be delivered effectively and efficiently. We have previously developed a clinical decision support system (CDS) for MT using a multicenter multidisciplinary user‐centered design study. Here we examine its impact when administering a MT.Study Design and MethodsWe conducted a randomized simulation trial to compare a CDS for MT with a paper‐based MT protocol for the management of simulated hemorrhage. A total of 44 specialist physicians, trainees (residents), and nurses were recruited across critical care to participate in two 20‐min simulated bleeding scenarios. The primary outcome was the decision velocity (correct decisions per hour) and overall task completion. Secondary outcomes included cognitive workload and System Usability Scale (SUS).ResultsThere was a statistically significant increase in decision velocity for CDS‐based management (mean 8.5 decisions per hour) compared to paper based (mean 6.9 decisions per hour; p .003, 95% CI 0.6–2.6). There was no significant difference in the overall task completion using CDS‐based management (mean 13.3) compared to paper‐based (mean 13.2; p .92, 95% CI ‐1.2–1.3). Cognitive workload was statistically significantly lower using the CDS compared to the paper protocol (mean 57.1 vs. mean 64.5, p .005, 95% CI 2.4–12.5). CDS usability was assessed as a SUS score of 82.5 (IQR 75–87.5).DiscussionCompared to paper‐based management, CDS‐based MT supports more time‐efficient decision‐making by users with limited CDS training and achieves similar overall task completion while reducing cognitive load. Clinical implementation will determine whether the benefits demonstrated translate to improved patient outcomes.

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The haemostasis traffic light: a pragmatic tool for bleeding management

Cited by 6 publications

References 8 publications

Uso de Concentrados de Fibrinógeno para el Tratamiento de la Hipofibrinogenemia Adquirida

Uso de Concentrados de Fibrinógeno para el Tratamiento de la Hipofibrinogenemia Adquirida

Multicenter, multidisciplinary user‐centered design of a clinical decision‐support and simulation system for massive transfusion

Clinical decision support versus a paper‐based protocol for massive transfusion: Impact on decision outcomes in a simulation study

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