scholarly journals Tranexamic Acid (TXA) in Trauma Patients: Barriers to Use among Trauma Surgeons and Emergency Physicians

2017 ◽  
Vol 2017 ◽  
pp. 1-5 ◽  
Author(s):  
Abdulaziz Alburaih
Keyword(s):  
Tranexamic Acid ◽  
Massive Transfusion ◽  
Positive Impact ◽  
National Level ◽  
Trauma Patients ◽  
Emergency Physicians ◽  
Major Barrier ◽  
Massive Transfusion Protocol ◽  
Trauma Surgeons ◽  
Transfusion Protocol

Objective.Tranexamic Acid (TXA) is currently the only drug with prospective clinical evidence supporting its use in bleeding trauma patients. We sought to better understand the barriers preventing its use and elicit suggestions to further its use in trauma patients in the state of Maryland.Methods. This is a cross-sectional study.Results. The overall response rate was 38%. Half of all participants reported being familiar with the CRASH-2 trial and MATTERs study. Half reported being aware of TXA as part of their institution’s massive transfusion protocol. The majority of participants felt that TXA would have a significant positive impact on the survival of trauma patients. A majority also felt that the use of TXA would increase if its administration was the responsibility of both trauma surgeons and emergency physicians.Conclusion. Only half of responders reported being aware of TXA as being part of their institution’s massive transfusion protocol. Lack of awareness of the clinical data supporting its use is a major barrier. However, most trauma providers and emergency physicians do have a favorable view of TXA and support its incorporation into massive transfusion protocols. We believe that more studies of this kind on both state and national level are needed.

Quality Management of massive transfusion protocol incorporating tranexamic acid adherence

2018 ◽  
Vol 57 (6) ◽  
pp. 785-789
Author(s):  
Weiwei Shi ◽  
Ram Al-Sabti ◽  
Peter A. Burke ◽  
Mauricio Gonzalez ◽  
Nelson Mantilla-Rey ◽  
...  
Keyword(s):  
Quality Management ◽  
Tranexamic Acid ◽  
Massive Transfusion ◽  
Massive Transfusion Protocol ◽  
Transfusion Protocol

scholarly journals Not only in trauma patients: hospital-wide implementation of a massive transfusion protocol

2013 ◽  
Vol 24 (3) ◽  
pp. 162-168 ◽  
Author(s):  
L. M. Baumann Kreuziger ◽  
C. T. Morton ◽  
A. T. Subramanian ◽  
C. P. Anderson ◽  
D. J. Dries
Keyword(s):  
Massive Transfusion ◽  
Trauma Patients ◽  
Massive Transfusion Protocol ◽  
Transfusion Protocol

scholarly journals Comparison of the impact of applications of Targeted Transfusion Protocol and Massive Transfusion Protocol in trauma patients

2017 ◽  
Vol 70 (6) ◽  
pp. 626 ◽  
Author(s):  
Shahram Paydar ◽  
Hosseinali Khalili ◽  
Golnar Sabetian ◽  
Behnam Dalfardi ◽  
Shahram Bolandparvaz ◽  
...  
Keyword(s):  
Massive Transfusion ◽  
Trauma Patients ◽  
Massive Transfusion Protocol ◽  
The Impact ◽  
Transfusion Protocol

The Use of Recombinant FVIIa in a Structured Massive Transfusion Protocol: A Novel Approach.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 4142-4142
Author(s):  
Majed A. Refaai ◽  
Kathryn Tchorz ◽  
John Forestner ◽  
Raymond Morris ◽  
Marty Koch ◽  
...  
Keyword(s):  
Massive Transfusion ◽  
Blood Type ◽  
Blood Component ◽  
P Value ◽  
Trauma Patients ◽  
Blood Products ◽  
Packed Red Blood Cells ◽  
Massive Transfusion Protocol ◽  
Novel Approach ◽  
Transfusion Protocol

Abstract Background: Trauma has become the second leading cause of death worldwide, despite advances in modern trauma resuscitation practices. Appropriate and timely blood component therapy in the severely injured trauma patient could prevent adverse outcome due to coagulopathy. Recombinant FVIIa has been used to achieve adequate hemostasis in trauma patients in the field. Materials and Methods: In June 2004, a massive transfusion protocol (MTP) was established in Parkland Memorial Hospital in Dallas, TX for patients presenting with trauma. Major goals of the MTP were 1) to achieve faster turn around times for these products, 2) to provide an appropriate ratio of blood components in order to prevent coagulopathy of massive transfusion and use of rFVIIa to achieve better hemostasis, and 3) to reduce wastage of blood products. At all times, the Blood Bank keeps ready for emergency release 4 units each of type A and O thawed plasma (TP) and 2 units of AB TP (5 days expiration). The MTP consists of three shipments that may be repeated, if necessary. Each shipment consists of 5 packed red blood cells (PRBCs) and 2 TP. One dose of platelets is added to the second shipment, and one dose of cryoprecipitate (10 units) and rFVIIa (4.8 mg) is added to the third shipment. If the MTP goes to the 6th shipment, 2.4 mg rFVIIa is given. Once initiated, the first MTP shipment is ready for pick up in 15 minutes. If blood type can not be determined, type O RBCs with type AB TP are sent in the first shipment (Rh matching depends upon inventory and the patient’s gender). We compared MTP blood component usage in 173 trauma patients during a 24-months period with pre-MTP historical data in 67 trauma patients from the previous 12 months. Results: The average TAT of the first shipment in MTP was 9 ± 0.4 minutes. No TAT assessments of the first shipment were possible in the pre-MTP cases because there was no initiation time available. When comparing the average TATs of second and third shipments of MTP versus pre-MTP cases, however, significant reductions were achieved (18 ± 1.8 vs. 42 ± 30 and 30 ± 2.5 vs. 44 ± 31 minutes, respectively). There was a significant reduction in blood component usage with MTP as compared to pre-MTP (Table) though the mortality had not changed. The blood component wastage (especially cryoprecipitate) had decreased significantly. Conclusions: There was a significant reduction in TAT and blood products used in following establishment of MTP; this was most likely due to prevention and/or early treatment of dilutional coagulopathy and achievement of adequate hemostasis with use of rFVIIa. Table Group PRBCs Thawed Plasma Platelets CRYO rFVIIa TAT (2nd Shipment) TAT (3rd Shipment) *Pre-MTP (n = 20), CRYO = cryoprecipitate, TAT = turn-around time, N/P = not performed Pre-MTP (n = 67) 24.2 ± 16.3 11.2 ± 8.3 3.1 ± 3.5 1.6 ± 1.7 0.2 ± 0.4 42 ± 30* 44 ± 31* MTP (n = 173) 17.5 ± 12.4 6.7 ± 5.6 1.2 ± 1.4 0.7 ± 0.8 0.4 ± 0.6 18 ± 1.8 33 ± 2.5 P value 0.0055 <0.001 <0.001 <0.001 00.0032 N/P N/P

scholarly journals Fluid Resuscitation and Massive Transfusion Protocol in Pediatric Trauma

2016 ◽  
Vol 33 (2) ◽  
pp. 91-99
Author(s):  
Vesna Marjanović ◽  
Ivana Budić
Keyword(s):  
Hemorrhagic Shock ◽  
Fluid Resuscitation ◽  
Early Identification ◽  
Massive Transfusion ◽  
Pediatric Trauma ◽  
Current Data ◽  
Trauma Patients ◽  
Volume Resuscitation ◽  
Massive Transfusion Protocol ◽  
Transfusion Protocol

Summary Trauma is the leading cause of morbidity and mortality in children due to the occurrence of hemorrhagic shock. Hemorrhagic shock and its consequences, anemia and hypovolemia, decrease oxygen delivery, due to which appropriate transfusion and volume resuscitation are critical. Guidelines for massive transfusion, in the pediatric trauma, have not been defined yet. Current data indicate that early identification of coagulopathy and its treatment with RBSs, plasma and platelets in a 1:1:1 unit ratio, and limited use of crystalloids may improve survival in pediatric trauma patients.

1561: OVERACTIVATION OF MASSIVE TRANSFUSION PROTOCOL IN TRAUMA VERSUS NON-TRAUMA PATIENTS AND OUTCOMES

2018 ◽  
Vol 46 (1) ◽  
pp. 765-765
Author(s):  
Nikhita Gadi ◽  
Jayaramakrishna Depa ◽  
Payal Ram ◽  
Tina Adjei-Bosompem ◽  
Scott Lee ◽  
...  
Keyword(s):  
Massive Transfusion ◽  
Trauma Patients ◽  
Massive Transfusion Protocol ◽  
Transfusion Protocol

scholarly journals Effects of Massive Transfusion Protocol Implementation in Trauma Patients at a Level I Trauma Center

2020 ◽  
Vol 33 (2) ◽  
pp. 74-80
Author(s):  
Hyun Woo Sun ◽  
Sang Bong Lee ◽  
Sung Jin Park ◽  
Chan Ik Park ◽  
Jae Hun Kim
Keyword(s):  
Trauma Center ◽  
Massive Transfusion ◽  
Trauma Patients ◽  
Protocol Implementation ◽  
Massive Transfusion Protocol ◽  
Level I ◽  
Transfusion Protocol

Accuracy of CHULA (Class-4 Hemorrhage Unresponsive to Lactated Ringer’s) Criteria for Massive Transfusion Protocol Activation in Trauma Patients

2020 ◽  
Vol 103 (10) ◽  
pp. 1042-1047
Keyword(s):  
Blood Transfusion ◽  
Injury Severity ◽  
Massive Transfusion ◽  
Demographic Data ◽  
Clinical Signs ◽  
Trauma Patients ◽  
Packed Red Blood Cells ◽  
Massive Transfusion Protocol ◽  
Sensitivity Specificity ◽  
Transfusion Protocol

Background: In massive bleeding trauma patients, the use of massive transfusion protocol (MTP) has been shown to improve the outcome. However, the triggers for MTP activation vary among institutions. One of the most commonly used scoring systems to predict massive transfusion (MT) is the assessment of blood consumption (ABC) score. The authors’ institution has used a simple clinical criterion, the Class-4 Hemorrhage Unresponsive to Lactated Ringer’s (CHULA criteria), as a trigger for MTP activation. Objective: To identify the accuracy of CHULA criteria for MTP activation in trauma patients. Materials and Methods: Between April 2013 and April 2016, the authors retrospectively collected the data of trauma patients receiving blood transfusion in the first 24 hours at King Chulalongkorn Memorial Hospital, including demographic data, trauma scores, amount of blood transfusion, and mortality. The detail of CHULA criteria included 1) a patient with clinical signs of Class-4 hemorrhage, 2) not responding to one to two liters of Lactated Ringer’s bolus, and 3) had suspected ongoing bleeding. MT was defined as 1) packed red blood cells (PRC) transfusion of equal to or greater than 10 units in 24 hours, or 2) PRC transfusion of more than four units in the first hour. The accuracy of CHULA criteria for MTP activation was analyzed. Comparison between CHULA criteria and ABC score (of equal to or greater than 2) was also performed. Results: Three hundred fifty-eight patients were included in the present study, 292 males and 66 females. The mechanisms of injury were 68% blunt and 32% penetrating, with an average injury severity score of 21. MTP was activated by CHULA criteria in 100 patients and 73 received MT. Of the 258 patients who did not meet CHULA criteria, five received MT. As a trigger for MT activation, CHULA criteria had sensitivity, specificity, and accuracy of 93.6%, 90.4%, and 91%, respectively; while ABC score had sensitivity, specificity, and accuracy of 62.8%, 78.9%, and 75.4%, respectively. Conclusion: CHULA criteria can predict MT in trauma patients with 91% accuracy. When compared with ABC score, CHULA criteria were not inferior to ABC score in predicting MT. Keywords: Massive transfusion, CHULA criteria, ABC score

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