Marco Botteri1, Simone Celi2, Giovanna Perone2, Enrica Prati3, Paola Bera2, Guido Francesco Villa4, Claudio Mare4, Giuseppe Maria Sechi4, Alberto Zoli4, Nazzareno Fagoni5. 1. AAT Brescia, Agenzia Regionale Emergenza Urgenza (AREU). Department of Anesthesia, Intensive Care and Emergency, ASST Spedali Civili University Hospital, Piazzale Spedali Civili, Brescia 1-25123, Italy; Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), Milano, Italy. 2. AAT Brescia, Agenzia Regionale Emergenza Urgenza (AREU). Department of Anesthesia, Intensive Care and Emergency, ASST Spedali Civili University Hospital, Piazzale Spedali Civili, Brescia 1-25123, Italy. 3. Immuno-Haematology and Transfusional Medicine Service (SIMT), ASST Spedali Civili University Hospital, Brescia, Italy. 4. Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), Milano, Italy. 5. AAT Brescia, Agenzia Regionale Emergenza Urgenza (AREU). Department of Anesthesia, Intensive Care and Emergency, ASST Spedali Civili University Hospital, Piazzale Spedali Civili, Brescia 1-25123, Italy; Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), Milano, Italy; Department of Molecular and Translational Medicine, University of Brescia, Italy. Electronic address: nazzareno.fagoni@unibs.it.
Abstract
INTRODUCTION: Hemorrhage in major trauma is life-threatening and the activation of the Massive Transfusion Protocol (MTP) was found to reduce the time to transfusion and mortality. The purpose was (i) to verify whether MTP activation identifies patients that require massive transfusions once admitted to the Emergency Department (ED), (ii) to establish whether pre-hospital MTP activation reduces the time to transfusion on arrival at the ED, (iii) to identify the variable that best predicts MTP activation. MATERIALS AND METHODS: This is a retrospective, single-center study. The MTP was implemented at the end of 2012; it was activated for major trauma in pre-hospital setting on the basis on established criteria. Pre-hospital MTP activation aimed to make blood products available prior to the patients' arrival at the ED. The blood products are transfused when the patient arrives at the hospital. RESULTS: The MTP was activated in pre-hospital setting in 219 patients. On arrival at the hospital, the Trauma Team Leader confirmed MTP activation in 146 (66.7%) patients. Patients with MTP criteria received a higher amount of blood products than the patients without MTP criteria, median 7 (IQR 2-13) units versus 2 (0-6) units, respectively (P < 0.001). At the same time, patients with a Shock Index ≥ 0.9 received more transfusions (5.5 [2-13] units) compared with patients characterized by a lower SI (2 [0-7.25] units, P = 0.009). 146 patients were transfused in the first hour of ED admission. Poisson's multiple regression shows that the SI is the variable that better predicted MTP activation compared to age, gender and the number of injured sites. CONCLUSIONS: Pre-hospital MTP activation is useful to identify patients that require an urgent blood transfusion on arrival at the ED. Further analysis should be considered to evaluate the implementation of the Shock Index as a criterion to activate MTP.
INTRODUCTION: Hemorrhage in major trauma is life-threatening and the activation of the Massive Transfusion Protocol (MTP) was found to reduce the time to transfusion and mortality. The purpose was (i) to verify whether MTP activation identifies patients that require massive transfusions once admitted to the Emergency Department (ED), (ii) to establish whether pre-hospital MTP activation reduces the time to transfusion on arrival at the ED, (iii) to identify the variable that best predicts MTP activation. MATERIALS AND METHODS: This is a retrospective, single-center study. The MTP was implemented at the end of 2012; it was activated for major trauma in pre-hospital setting on the basis on established criteria. Pre-hospital MTP activation aimed to make blood products available prior to the patients' arrival at the ED. The blood products are transfused when the patient arrives at the hospital. RESULTS: The MTP was activated in pre-hospital setting in 219 patients. On arrival at the hospital, the Trauma Team Leader confirmed MTP activation in 146 (66.7%) patients. Patients with MTP criteria received a higher amount of blood products than the patients without MTP criteria, median 7 (IQR 2-13) units versus 2 (0-6) units, respectively (P < 0.001). At the same time, patients with a Shock Index ≥ 0.9 received more transfusions (5.5 [2-13] units) compared with patients characterized by a lower SI (2 [0-7.25] units, P = 0.009). 146 patients were transfused in the first hour of ED admission. Poisson's multiple regression shows that the SI is the variable that better predicted MTP activation compared to age, gender and the number of injured sites. CONCLUSIONS: Pre-hospital MTP activation is useful to identify patients that require an urgent blood transfusion on arrival at the ED. Further analysis should be considered to evaluate the implementation of the Shock Index as a criterion to activate MTP.
Authors: Marco Tartaglione; Luca Carenzo; Lorenzo Gamberini; Cristian Lupi; Aimone Giugni; Carlo Alberto Mazzoli; Valentina Chiarini; Silvia Cavagna; Davide Allegri; John B Holcomb; David Lockey; Giovanni Sbrana; Giovanni Gordini; Carlo Coniglio Journal: BMJ Open Date: 2022-05-30 Impact factor: 3.006
Authors: Giuseppe Stirparo; Aurea Oradini-Alacreu; Carlo Signorelli; Giuseppe Maria Sechi; Alberto Zoli; Nazzareno Fagoni Journal: Intern Emerg Med Date: 2022-09-06 Impact factor: 5.472
Authors: Giuseppe Stirparo; Nazzareno Fagoni; Lorenzo Bellini; Aurea Oradini-Alacreu; Maurizio Migliari; Guido Francesco Villa; Marco Botteri; Carlo Signorelli; Giuseppe Maria Sechi; Alberto Zoli Journal: Acta Anaesthesiol Scand Date: 2022-08-05 Impact factor: 2.274