The use of trauma transfusion pathways for blood component transfusion in the civilian population: a systematic review and meta‐analysis^*

Abstract

This study was undertaken to determine if, amongst civilian trauma patients requiring massive transfusion (MT), the use of a formal trauma transfusion pathway (TTP), in comparison with transfusion without a TTP, is associated with a reduction in mortality, or changes in indices of coagulation, blood product utilisation and complications. A systematic review of three bibliographic databases, reference lists and conference proceedings was conducted. Studies were included if comparisons were made between patients receiving transfusion with and without a TTP. Data were extracted by two independent reviewers on population characteristics, transfusion strategies, blood product utilisation, indices of coagulation, clinical outcomes and complications. Data were pooled using a random effects model and heterogeneity explored. Seven observational studies met all eligibility criteria. Amongst 1801 patients requiring MT, TTPs were associated with a significant reduction in mortality (RR 0·69, 95% CI 0·55, 0·87). No significant increase in the mean number of PRBC transfused between TTP and control patients was seen (MD −1·17 95% CI −2·70, 0·36). When studies assessing only trauma patients were considered, TTPs were associated with a reduction in the mean number of units of plasma transfused (MD −2·63, 95% CI −4·24, −1·01). In summary, the use of TTPs appears to be associated with a reduction in mortality amongst trauma patients requiring MT without a clinically significant increase in the number of PRBC transfused and a potential reduction in plasma transfusion. Effects of TTPs on platelet transfusion, indices of coagulation and complications remain unclear. A randomised controlled trial is warranted.

Resuscitate early with plasma and platelets or balance blood products gradually

“…Several systematic reviews and meta-analyses have summarized the findings from observational studies associating reduced in-hospital mortality with the establishment of massive transfusion protocols in Level I trauma centers (7 studies) 11, 12 and with increased plasma and platelet:RBC ratios closer to 1:1 (16 studies). 13–16 In addition, clinical practice guidelines regarding the use of plasma 17 and platelet 18 transfusion for massively hemorrhaging patients have been published recently.…”

Prehospital shock index, modified shock index, and pulse pressure heart rate ratio as predictors of massive blood transfusions in modern warfare injuries: A retrospective analysis

“…Vogt et al, in 2012, have found that early activation of MT protocol in resuscitation has found to have a double benefit of improved patient outcome as well as limit the usage of blood components and hence decreasing the complications associated. 18 The SI has proved to be a robust marker of ongoing hemorrhage, the need for MTs and is easily available in almost every setting. Vandromme et al has found SI to be important clinical marker in a prehospital setting but will need further evaluation before incorporating into clinical practice.…”

Clinical transfusion practice update: haemovigilance, complications, patient blood management and national standards

“…Use of a massive transfusion protocol (MTP) improves outcomes. It results in a significant reduction in mortality without increased use of blood components 26 . MTPs facilitate communication between clinical stakeholders and the transfusion laboratory.…”