BACKGROUND: Major haemorrhage protocols (MHP) are required as part of damage control resuscitation regimens in modern trauma care. The primary objectives of this study were to ascertain whether a MHP improved blood product administration and reduced waste compared to traditional massive transfusion protocols (MTP). METHODS: Datasets on adult trauma admissions 1 year prior and 1 year post implementation of a MHP at a Level 1 trauma centre were obtained from the trauma registry. Demographic and clinical data were collected prospectively including mechanism of injury, physiological observations, ICU admission and length of stay. The volume of blood components (packed red blood cells, platelets, cryoprecipitate and fresh frozen plasma) issued, transfused, returned to stock and wasted within the first 24h was gathered retrospectively. RESULTS: Over the 2-year study period 2986 patient records were available for analysis. 40 patients required a 10+ Units of packed red blood ells transfusion in the MTP group vs. 56 patients post MHP implementation. The administration of blood component therapy improved significantly post MHP implementation. FFP:PRBC transfusion improved from 1:3 to 1:2 (p<0.01) and CRYO:PRBC improved from 1:10 to 1:7 (p<0.05). We reported a significant reduction in the waste of platelets from 14% to 2% (p<0.01). Outcomes had improved: Median hospital length of stay was reduced from 54 days to 26 days (p<0.05). CONCLUSION: Implementation of a MHP results in improved delivery of blood components and a reduction in the waste of blood products compared to the older model of MTP. In combination with educational programmes MHP can significantly improve blood product administration and patient outcomes in trauma haemorrhage. LEVEL OF EVIDENCE: Level III diagnostic test study. Crown
BACKGROUND: Major haemorrhage protocols (MHP) are required as part of damage control resuscitation regimens in modern trauma care. The primary objectives of this study were to ascertain whether a MHP improved blood product administration and reduced waste compared to traditional massive transfusion protocols (MTP). METHODS: Datasets on adult trauma admissions 1 year prior and 1 year post implementation of a MHP at a Level 1 trauma centre were obtained from the trauma registry. Demographic and clinical data were collected prospectively including mechanism of injury, physiological observations, ICU admission and length of stay. The volume of blood components (packed red blood cells, platelets, cryoprecipitate and fresh frozen plasma) issued, transfused, returned to stock and wasted within the first 24h was gathered retrospectively. RESULTS: Over the 2-year study period 2986 patient records were available for analysis. 40 patients required a 10+ Units of packed red blood ells transfusion in the MTP group vs. 56 patients post MHP implementation. The administration of blood component therapy improved significantly post MHP implementation. FFP:PRBC transfusion improved from 1:3 to 1:2 (p<0.01) and CRYO:PRBC improved from 1:10 to 1:7 (p<0.05). We reported a significant reduction in the waste of platelets from 14% to 2% (p<0.01). Outcomes had improved: Median hospital length of stay was reduced from 54 days to 26 days (p<0.05). CONCLUSION: Implementation of a MHP results in improved delivery of blood components and a reduction in the waste of blood products compared to the older model of MTP. In combination with educational programmes MHP can significantly improve blood product administration and patient outcomes in trauma haemorrhage. LEVEL OF EVIDENCE: Level III diagnostic test study. Crown
Authors: Karim Asehnoune; Zsolt Balogh; Giuseppe Citerio; Andre Cap; Timothy Billiar; Nino Stocchetti; Mitchell J Cohen; Paolo Pelosi; Nicola Curry; Christine Gaarder; Russell Gruen; John Holcomb; Beverley J Hunt; Nicole P Juffermans; Mark Maegele; Mark Midwinter; Frederick A Moore; Michael O'Dwyer; Jean-François Pittet; Herbert Schöchl; Martin Schreiber; Philip C Spinella; Simon Stanworth; Robert Winfield; Karim Brohi Journal: Intensive Care Med Date: 2017-07-29 Impact factor: 17.440
Authors: A Driessen; N Schäfer; V Albrecht; M Schenk; M Fröhlich; E K Stürmer; M Maegele Journal: Eur J Trauma Emerg Surg Date: 2014-10-25 Impact factor: 3.693
Authors: Jeannie L Callum; Calvin H Yeh; Andrew Petrosoniak; Mark J McVey; Stephanie Cope; Troy Thompson; Victoria Chin; Keyvan Karkouti; Avery B Nathens; Kimmo Murto; Suzanne Beno; Jacob Pendergrast; Andrew McDonald; Russell MacDonald; Neill K J Adhikari; Asim Alam; Donald Arnold; Lee Barratt; Andrew Beckett; Sue Brenneman; Hina Razzaq Chaudhry; Allison Collins; Margaret Harvey; Jacinthe Lampron; Clarita Margarido; Amanda McFarlan; Barto Nascimento; Wendy Owens; Menaka Pai; Sandro Rizoli; Theodora Ruijs; Robert Skeate; Teresa Skelton; Michelle Sholzberg; Kelly Syer; Jami-Lynn Viveiros; Josee Theriault; Alan Tinmouth; Rardi Van Heest; Susan White; Michelle Zeller; Katerina Pavenski Journal: CMAJ Open Date: 2019-09-03
Authors: Matthew J Pommerening; Michael D Goodman; John B Holcomb; Charles E Wade; Erin E Fox; Deborah J Del Junco; Karen J Brasel; Eileen M Bulger; Mitch J Cohen; Louis H Alarcon; Martin A Schreiber; John G Myers; Herb A Phelan; Peter Muskat; Mohammad Rahbar; Bryan A Cotton Journal: Injury Date: 2015-02-04 Impact factor: 2.586
Authors: V Albrecht; N Schäfer; E K Stürmer; A Driessen; L Betsche; M Schenk; M Maegele Journal: Eur J Trauma Emerg Surg Date: 2015-11-30 Impact factor: 3.693