Massive Transfusion Protocols in Obstetric Hemorrhage: Theory versus Reality

Author(s):  
Bahram Salmanian ◽  
Steven L. Clark ◽  
Shiu-Ki R. Hui ◽  
Sarah Detlefs ◽  
Soroush Aalipour ◽  
...  

Objective Massive transfusion protocols are widely implemented in obstetrical practice in case of severe hemorrhage; however, different recommendations exist regarding the appropriate ratios of blood product components to be transfused. We report our extensive experience with massive component transfusion in a referral center in which the standard massive transfusion protocol is modified by ongoing clinical and laboratory evaluation. Study Design A retrospective chart review of all patients who had massive transfusion protocol activation in a level 4 referral center for obstetrical practice was performed from January 2014 to January 2020. Data collected included the etiology of obstetrical hemorrhage, number of blood products of each type transfused, crystalloid infusion, and several indices of maternal morbidity and mortality. Data are presented with descriptive statistics. Results A total of 62 patients had massive transfusion protocol activation, of which 97% received blood products. Uterine atony was found to be the most common etiology for massive hemorrhage (34%), followed by placenta accreta spectrum (32%). The mean estimated blood loss was 1,945 mL. A mean of 6.5 units of packed red blood cells, 14.8 units of fresh frozen plasma and cryoprecipitate, and 8.3 units of platelets were transfused per patient. No maternal deaths were seen. Conclusion The ratios of transfused packed red blood cell to fresh frozen plasma/cryoprecipitate and of packed red blood cell to platelet units varied significantly from the fixed initial infusion ratio called for by our massive transfusion protocol resulting in universally favorable maternal outcomes. When rapid laboratory evaluation of hematologic and clotting parameters is available, careful use of this information may facilitate safe modification of an initial fixed transfusion ratio based on etiology of the hemorrhage and individual patient response. Key Points

2010 ◽  
Vol 210 (1) ◽  
pp. 117 ◽  
Author(s):  
Marianne J. Vandromme ◽  
Christopher W. Snyder ◽  
Gerald McGwin ◽  
Jordan A. Weinberg ◽  
Jeffrey D. Kerby

2017 ◽  
Vol 106 (3) ◽  
pp. 255-260 ◽  
Author(s):  
T. Söderlund ◽  
T. Ketonen ◽  
L. Handolin

Background and Aims: Massive transfusion protocol seems to improve outcome in massively bleeding trauma patients, but not pelvic fracture patients. The aim of this study was to evaluate the effect of massive transfusion protocol on the mortality and fluid resuscitation of shocked pelvic fracture patients. Material and Methods: This is a trauma register study from a single hospital. From the trauma registry patients with pelvic fracture, injury severity score >15, admission base excess below −5, age >15 years, blunt trauma, and primary admission from the scene were identified. Patients were divided into two groups: Group 1—pre-massive transfusion protocol (2006–2009) and Group 2—post-massive transfusion protocol (2010–2013). Basic characteristics and intensive care unit length of stay, mortality, and fluid resuscitation data were retrieved from the registry. Standardized mortality ratio was assessed using revised injury severity classification, version II methodology. Results: Altogether, 102 patients were identified. Group 1 ( n = 56) and Group 2 ( n = 46) were comparable in their basic characteristics. The observed mortality was 35.7% and 26.1% in Groups 1 and 2, respectively. The standardized mortality ratio failed to reveal any difference between observed and expected mortality in either group. In the emergency room, the use of crystalloids decreased from 5.3 ± 3.4 to 3.3 ± 1.8 L ( p = 0.002) with increased use of fresh frozen plasma (2.9 ± 4.4 vs 5.1 ± 5.3, p = 0.007). Conclusion: No improvement in the adjusted survival of shocked pelvic fracture patients is apparent after implementation of massive transfusion protocol. Implementation of massive transfusion protocol is associated with a higher use of fresh frozen plasma and improved ratio of fresh frozen plasma:red blood cell toward the targeted 1:1 and decreased use of crystalloids.


Transfusion ◽  
2015 ◽  
Vol 56 (4) ◽  
pp. 816-826 ◽  
Author(s):  
Kavitha Subramaniam ◽  
Katrina Spilsbury ◽  
Oyekoya T. Ayonrinde ◽  
Faye Latchmiah ◽  
Syed A. Mukhtar ◽  
...  

2009 ◽  
Vol 9 (10) ◽  
pp. 107S-108S
Author(s):  
Albert Pull Ter Gunne ◽  
Richard Skolasky ◽  
Hillary Ross ◽  
David Cohen

2021 ◽  
Vol 49 (5) ◽  
pp. 365-372
Author(s):  
Cyril Pernod ◽  
◽  
Laurie Fraticelli ◽  
Guillaume Marcotte ◽  
Bernard Floccard ◽  
...  

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