Cyril Pernod1, Laurie Fraticelli2, Guillaume Marcotte3, Bernard Floccard3, Thibaut Girardot4, Clement Claustre5, Carlos El Khoury6, Thomas Rimmele4. 1. Department of Anesthesiology and Intensive care medicine, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France. 2. RESUVal Network, Statistical Unit, Lucien Hussel Hospital, Vienne, France;EA4129, Systemic Health Pathway Laboratory, University Lyon, Lyon, France. 3. Department of Anaesthesia and Critical Care Medicine, Edouard Herriot Hospital, Lyon, France. 4. Department of Anaesthesia and Critical Care Medicine, Edouard Herriot Hospital, Lyon, France;EA7426, Pathophysiology of Injury-Induced Immunosuppression (Pi3), Hospices Civils de Lyon, Claude Bernard Lyon 1 University, Lyon, France. 5. RESUVal Network, Statistical Unit, Lucien Hussel Hospital, Vienne, France. 6. RESUVal Network, Statistical Unit, Lucien Hussel Hospital, Vienne, France; Emergency Department and RESCUe Network, Lucien Hussel Hospital, Vienne, France;Hesper Ea, Claude Bernard Lyon 1 University, Lyon, France.
Abstract
OBJECTIVE: The aim of this study was to describe the evolution of transfusion practices following the introduction of tranexamic acid (TXA) and ROTEMVR in a trauma resuscitation unit (TRU) from a French teaching hospital (FTH). METHODS: This is a single-centre, retrospective study at a TRU from a FTH. All trauma patients aged 18 years or more and transfused with at least 4 red blood cells (RBCs) within 24 hours after trauma, from 2011 to 2016, were included. The primary objective was to analyse transfusion practices over this time period. The secondary objectives aimed at assessing differences between populations according to the fresh frozen plasma (FFP):RBC ratio applied. RESULTS: A total of 122 patients were included. There was a significant decrease in the proportion of patients requiring at least 4 RBCs 24 hours after trauma (9% vs. 3%, P trend < .0001) as well as a decrease in the proportion of patients with a high FFP:RBC ratio (86% vs. 62% at 6 hours, P trend ¼ .0056 and 86% vs. 56% at 24 hours, P trend ¼ .0047). After 2013, fibrinogen was administered to more than 70% of patients and TXA to 100% of them. The observed mortality was lower than the predicted one, irrespective of FFP:RBC ratio. CONCLUSION: An important evolution of practices occurred including a decrease in the proportion of transfusions and use of high FFP:RBC ratios. The origin of these changes is multifactorial, likely including the systematic use of TXA and optimisation of the ROTEM protocol for fibrinogen administration.
OBJECTIVE: The aim of this study was to describe the evolution of transfusion practices following the introduction of tranexamic acid (TXA) and ROTEMVR in a trauma resuscitation unit (TRU) from a French teaching hospital (FTH). METHODS: This is a single-centre, retrospective study at a TRU from a FTH. All trauma patients aged 18 years or more and transfused with at least 4 red blood cells (RBCs) within 24 hours after trauma, from 2011 to 2016, were included. The primary objective was to analyse transfusion practices over this time period. The secondary objectives aimed at assessing differences between populations according to the fresh frozen plasma (FFP):RBC ratio applied. RESULTS: A total of 122 patients were included. There was a significant decrease in the proportion of patients requiring at least 4 RBCs 24 hours after trauma (9% vs. 3%, P trend < .0001) as well as a decrease in the proportion of patients with a high FFP:RBC ratio (86% vs. 62% at 6 hours, P trend ¼ .0056 and 86% vs. 56% at 24 hours, P trend ¼ .0047). After 2013, fibrinogen was administered to more than 70% of patients and TXA to 100% of them. The observed mortality was lower than the predicted one, irrespective of FFP:RBC ratio. CONCLUSION: An important evolution of practices occurred including a decrease in the proportion of transfusions and use of high FFP:RBC ratios. The origin of these changes is multifactorial, likely including the systematic use of TXA and optimisation of the ROTEM protocol for fibrinogen administration.
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