Glenn Ramsey1,2. 1. Department of Pathology, Feinberg School of Medicine, Northwestern University, Evanston, Illinois, USA. 2. Blood Bank, Department of Pathology, Northwestern Memorial Hospital, Chicago, Illinois, USA.
Abstract
BACKGROUND AND OBJECTIVES: The US AABB disaster task force recommends estimating 3 RBC units per admission (UPA) for mass casualty events (MCEs). In a previous analysis, median MCE UPA were 2·7 RBCs, 1·2 plasmas and 0·27 platelet doses (Vox Sang 2017; 112:648). Additional recent data were sought from the current era of balanced massive transfusion protocols (bMTPs). MATERIALS AND METHODS: Publications in English from 1980 to 2020 were reviewed for MCEs using ≥50 RBCs/event and with numbers of admissions available. MCE reports were stratified by era and event-wide or trauma-centre source. The bMTP era included all MCEs since 2010 plus a 2008 bMTP military report. STATISTICS: Mann-Whitney test. RESULTS: Thirty-two MCEs met analysis criteria. Event-wide reports used medians [interquartile ranges] of 1·8 [1·2-3·9] RBC, 0·6 [0·3-0·9] plasma and 0·14 [0·06-0·26] platelet-dose UPA. Trauma centres transfused 3·4 [2·7-6·3] RBC, 2·4 [1·3-4·1] plasma and 0·41 [0·34-0·50] platelet-dose UPA, all P < 0·05 vs event-wide. Same-event median post-day-1 transfusions were 50% of day-1 use for RBC, 28% for plasma and 16% for platelets. Compared to prior years, the median plasma/RBC transfusion ratio rose from 0·28 to 0·67 in the bMTP era (P < 0·01). In recent mass shootings, trauma centres transfused up to 42 platelets (range 0·45-0·57 UPA) on day 1. CONCLUSION: Based on available mass casualty data, we recommend planning for 3 RBC, 1 plasma and one-fourth platelet-dose units per admission for blood centres (event-wide), and 6, 4 and one-half UPA, respectively, for trauma centres, which have seen rising plasma usage and large mass-shooting platelet needs.
BACKGROUND AND OBJECTIVES: The US AABB disaster task force recommends estimating 3 RBC units per admission (UPA) for mass casualty events (MCEs). In a previous analysis, median MCE UPA were 2·7 RBCs, 1·2 plasmas and 0·27 platelet doses (Vox Sang 2017; 112:648). Additional recent data were sought from the current era of balanced massive transfusion protocols (bMTPs). MATERIALS AND METHODS: Publications in English from 1980 to 2020 were reviewed for MCEs using ≥50 RBCs/event and with numbers of admissions available. MCE reports were stratified by era and event-wide or trauma-centre source. The bMTP era included all MCEs since 2010 plus a 2008 bMTP military report. STATISTICS: Mann-Whitney test. RESULTS: Thirty-two MCEs met analysis criteria. Event-wide reports used medians [interquartile ranges] of 1·8 [1·2-3·9] RBC, 0·6 [0·3-0·9] plasma and 0·14 [0·06-0·26] platelet-dose UPA. Trauma centres transfused 3·4 [2·7-6·3] RBC, 2·4 [1·3-4·1] plasma and 0·41 [0·34-0·50] platelet-dose UPA, all P < 0·05 vs event-wide. Same-event median post-day-1 transfusions were 50% of day-1 use for RBC, 28% for plasma and 16% for platelets. Compared to prior years, the median plasma/RBC transfusion ratio rose from 0·28 to 0·67 in the bMTP era (P < 0·01). In recent mass shootings, trauma centres transfused up to 42 platelets (range 0·45-0·57 UPA) on day 1. CONCLUSION: Based on available mass casualty data, we recommend planning for 3 RBC, 1 plasma and one-fourth platelet-dose units per admission for blood centres (event-wide), and 6, 4 and one-half UPA, respectively, for trauma centres, which have seen rising plasma usage and large mass-shooting platelet needs.
Authors: Richard R Gammon; Lizabeth Rosenbaum; Rhonda Cooke; Mark Friedman; Linda Rockwood; Tracie Nichols; Sarah Vossoughi Journal: Transfusion Date: 2020-11-18 Impact factor: 3.337