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

Abstract

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.

Blood Lost: A Retrospective Review of Blood Wastage from a Massive Transfusion Protocol in a Tertiary Paediatric Hospital

“…Even with a low wastage rate, our mortality rates are similar to the existing literature, which is quoted to range from 33.3–59% at 24 h and 17–59% at 30 days [ 14 , 15 , 16 ].…”

Changes in plasma unit distributions to hospitals over a 10‐year period

“…At the same time, however, damage control resuscitation of massively bleeding patients emphasizes an early plasma transfusion strategy, often initially in a 1:1 ratio with transfused red blood cells, to address the significant number of trauma patients with early trauma‐induced coagulopathy . Early plasma use has been adopted in massive transfusion protocols (MTPs) for nontrauma recipients as well, although evidence for the efficacy of early plasma transfusion in this patient group is more limited . Having an MTP available usually requires the hospital transfusion service to maintain thawed plasma, usually group AB, for the management of patients of unknown ABO group.…”

Effective Use of the Hybrid Emergency Room System in the Treatment of Patients with Non-Traumatic Critical Care Diseases: a retrospective, observational study

“…These results could be attributed to prompt hemostatic treatment in the hybrid ER, as well as appropriate transfusion strategies. Prompt initiation of transfusion is a common strategy in trauma care [18][19][20]. Moreover, approximately 60% of patients administered transfusions received emergency transfusions in the hybrid ER; therefore, adaptation of these appropriate transfusion strategies to endogenous disease may also have been effective.…”