Whole Blood Versus Conventional Blood Component Massive Transfusion Protocol Therapy in Civilian Trauma Patients

2021 ◽  
pp. 000313482110497
Author(s):  
Janet S. Lee ◽  
Abid D. Khan ◽  
Franklin L. Wright ◽  
Robert C. McIntyre ◽  
Warren C. Dorlac ◽  
...  
Keyword(s):  
Whole Blood ◽  
Injury Severity ◽  
Massive Transfusion ◽  
Blood Component ◽  
Trauma Patients ◽  
Massive Transfusion Protocol ◽  
Civilian Trauma ◽  
Transfusion Volume ◽  
Blood Component Therapy ◽  
Transfusion Protocol

Background Military data demonstrating an improved survival rate with whole blood (WB) have led to a shift toward the use of WB in civilian trauma. The purpose of this study is to compare a low-titer group O WB (LTOWB) massive transfusion protocol (MTP) to conventional blood component therapy (BCT) MTP in civilian trauma patients. Methods Trauma patients 15 years or older who had MTP activations from February 2019 to December 2020 were included. Patients with a LTOWB MTP activation were compared to BCT MTP patients from a historic cohort. Results 299 patients were identified, 169 received LTOWB and 130 received BCT. There were no differences in age, gender, or injury type. The Injury Severity Score was higher in the BCT group (27 vs 25, P = .006). The LTOWB group had a longer transport time (33 min vs 26 min, P < .001) and a lower arrival temperature (35.8 vs 36.1, P < .001). Other hemodynamic parameters were similar between the groups. The LTOWB group had a lower in-hospital mortality rate compared to the BCT group (19.5% vs 30.0%, P = .035). There were no differences in total transfusion volumes at 4 hours and 24 hours. No differences were seen in transfusion reactions or hospital complications. Multivariable logistic regression identified ISS, age, and 24-hour transfusion volume as predictors of mortality. Discussion Resuscitating severely injured trauma patient with LTOWB is safe and may be associated with an improved survival.

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 &lt;0.001 &lt;0.001 &lt;0.001 00.0032 N/P N/P

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

What's in the Box? the Effectiveness of a Low-Volume Massive Transfusion Protocol

2016 ◽  
Vol 82 (7) ◽  
pp. 602-607 ◽  
Author(s):  
Katherine Baysinger ◽  
Merry E. Barnett ◽  
Mickey Ott ◽  
William Bromberg ◽  
Katherine McBride ◽  
...  
Keyword(s):  
Trauma Patient ◽  
Injury Severity ◽  
Massive Transfusion ◽  
Vital Signs ◽  
Study Cohort ◽  
Trauma Patients ◽  
Packed Red Blood Cells ◽  
Massive Transfusion Protocol ◽  
Significant Difference ◽  
Transfusion Protocol

Transfusion ratios approaching 1:1:1 of packed red blood cells (PRBCs) to fresh frozen plasma (FFP) to platelet have been shown to improve outcomes in trauma. There is little data available to describe in what quantity that ratio should be delivered. We hypothesized that lowering the total volume of products delivered in each protocol round would not adversely affect outcomes in the bleeding trauma patient. A retrospective review of 9732 trauma patients admitted to a rural Level I trauma center over a 3-year period was performed. Patients who received a massive transfusion (greater than 10 units of blood product transfused in the first 24 hours), between January 2012 and April 2015 were identified as the study cohort. In May of 2014, our institution switched from a massive transfusion protocol (MTP) that included 6 PRBCs:6 FFP:1 platelet to a lower volume massive transfusion protocol (LVMTP) that included 4 PRBG4 FFP:1 platelet. Data collected included patient demographics, vital signs, and outcomes. A total of 131 patients met study criteria. MTP was activated on 65 per cent of patients (57/88), receiving a massive transfusion during the 28 months before implementation of the new protocol. In contrast, LVMTP was activated in 100 per cent of patients (43/43) receiving a massive transfusion in the 12 months after implementation of the new protocol. There was no significant difference in age (36.6 vs 37.2, P = 0.87), injury severity score (29.8 vs 32.3, P = 0.45), or per cent penetrating mechanism (43.9 vs 37.2%, P = 0.503) when comparing MTP to LVMTP. In addition, there was no significant difference in mortality (47.4 vs 41.9%, P = 0.584), lengths of stay (13.5 vs 17.1, P = 0.258), or vent days (6.4 vs 8.2, P = 0.236) when comparing MTP to LVMTP. A LVMTP is safe and effective for the resuscitation of the trauma patient.

A Pilot Study of Stored Low Titer Group O Whole Blood + Component Therapy versus Component Therapy Only for Civilian Trauma Patients

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Anaar E. Siletz ◽  
Kevin J. Blair ◽  
Richelle J. Cooper ◽  
N. Charity Nguyen ◽  
Scott J. Lewis ◽  
...  
Keyword(s):  
Pilot Study ◽  
Whole Blood ◽  
Blood Component ◽  
Trauma Patients ◽  
Civilian Trauma ◽  
Blood Component Therapy ◽  
Titer Group

scholarly journals Bleeding Pelvic Fracture Patients: Evolution of Resuscitation Protocols

2017 ◽  
Vol 106 (3) ◽  
pp. 255-260 ◽  
Author(s):  
T. Söderlund ◽  
T. Ketonen ◽  
L. Handolin
Keyword(s):  
Pelvic Fracture ◽  
Injury Severity ◽  
Massive Transfusion ◽  
Fresh Frozen Plasma ◽  
Standardized Mortality Ratio ◽  
Massive Transfusion Protocol ◽  
Fresh Frozen ◽  
Mortality Ratio ◽  
Group 2 ◽  
Transfusion Protocol

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.

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

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.

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.

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