scholarly journals Evolution of practices in a French trauma centre: decrease in blood transfusions and fresh frozen plasma to red blood cell ratios.

2020 ◽  
Author(s):  
Cyril PERNOD ◽  
Laurie Fraticelli ◽  
Guillaume Marcotte ◽  
Bernard Floccard ◽  
Thibaut Girardot ◽  
...  
Keyword(s):  
Teaching Hospital ◽  
Fresh Frozen Plasma ◽  
Primary Objective ◽  
Trauma Centre ◽  
Trauma Patients ◽  
Trauma Resuscitation ◽  
All Cause Mortality ◽  
Fresh Frozen ◽  
Annual Proportion ◽  
Frozen Plasma

Abstract Background: Uncontrolled haemorrhage is still the leading cause of preventable death following trauma. Coagulation resuscitation strategies can be plasma-based or fibrinogen concentrate-based. The aim of this study was to describe the evolution of transfusion practices following the introduction of tranexamic acid (TXA) and ROTEM® in a trauma centre from a teaching hospital.Methods: This is a single-centre, retrospective study at a Trauma Resuscitation Unit (TRU) from a French teaching hospital. 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.Assessment of the annual proportion of patients transfused with more than 4 RBCs at 24h, proportion of application of high fresh frozen plasma (FFP):RBC ratio (≥ 1:2 ), and proportion of administration of fibrinogen with ROTEM® protocol and TXA was performed. The secondary objectives aimed at assessing differences between populations according to the FFP:RBC ratio applied and compare all-cause mortality at D30.Results: A total of 122 patients were included. Between 2011 and 2016, there was a significant decrease in the proportion of patients requiring at least 4 RBCs 24h after trauma (9% vs. 3%, Ptrend < 0.0001) as well as a decrease in the proportion of patients with a high FFP:RBC ratio (86% vs. 62% at 6h, Ptrend = 0.0056 and 86% vs. 56% at 24h, Ptrend = 0.0047). After 2013, fibrinogen was administered to more than 70% of patients and TXA to 100% of them. Adherence to the ROTEM® protocol for the administration of fibrinogen was significant. The observed mortality was lower than the predicted one, irrespective of FFP:RBC ratio.Conclusion: From 2011 to 2016, an important evolution of practices occurred in the TRU 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.

scholarly journals The epidemiology of overtransfusion of red cells in trauma resuscitation patients in the context of a mature massive transfusion protocol

2021 ◽  
Author(s):  
Timothy Cowan ◽  
Natasha Weaver ◽  
Alexander Whitfield ◽  
Liam Bell ◽  
Amanda Sebastian ◽  
...  
Keyword(s):  
Injury Severity ◽  
Haemoglobin Concentration ◽  
Fresh Frozen Plasma ◽  
Trauma Patients ◽  
Trauma Resuscitation ◽  
Packed Red Blood Cells ◽  
Clinical Consequences ◽  
Fresh Frozen ◽  
Transfusion Protocol ◽  
Frozen Plasma

Abstract Purpose Packed red blood cell (PRBC) transfusion remains an integral part of trauma resuscitation and an independent predictor of unfavourable outcomes. It is often administered urgently based on clinical judgement. These facts put trauma patients at high risk of potentially dangerous overtransfusion. We hypothesised that trauma patients are frequently overtransfused and overtransfusion is associated with worse outcomes. Methods Trauma patients who received PRBCs within 24 h of admission were identified from the trauma registry during the period January 1 2011–December 31 2018. Overtransfusion was defined as haemoglobin concentration of greater than or equal to 110 g/L at 24 h post ED arrival (± 12 h). Demographics, injury severity, injury pattern, shock severity, blood gas values and outcomes were compared between overtransfused and non-overtransfused patients. Results From the 211 patients (mean age 45 years, 71% male, ISS 27, mortality 12%) who met inclusion criteria 27% (56/211) were overtransfused. Patients with a higher pre-hospital systolic blood pressure (112 vs 99 mmHg p < 0.01) and a higher initial haemoglobin concentration (132 vs 124 p = 0.02) were more likely to be overtransfused. Overtransfused patients received smaller volumes of packed red blood cells (5 vs 7 units p = 0.049), fresh frozen plasma (4 vs 6 units p < 0.01) and cryoprecipitate (6 vs 9 units p = 0.01) than non-overtransfused patients. Conclusion More than a quarter of patients in our cohort were potentially given more blood products than required without obvious clinical consequences. There were no clinically relevant associations with overtransfusion.

scholarly journals Evolution of Practices in a French Trauma Centre: Decrease in Blood Transfusions and Fresh Frozen Plasma to Red Blood Cell Ratios

2021 ◽  
Vol 49 (5) ◽  
pp. 365-372
Author(s):  
Cyril Pernod ◽  
◽  
Laurie Fraticelli ◽  
Guillaume Marcotte ◽  
Bernard Floccard ◽  
...  
Keyword(s):  
Blood Cell ◽  
Red Blood Cell ◽  
Fresh Frozen Plasma ◽  
Trauma Centre ◽  
Blood Transfusions ◽  
Fresh Frozen ◽  
Frozen Plasma

Prothrombin complex concentrates versus fresh frozen plasma for warfarin reversal A systematic review and meta-analysis

2016 ◽  
Vol 116 (11) ◽  
pp. 879-890 ◽  
Author(s):  
Chatree Chai-Adisaksopha ◽  
Christopher Hillis ◽  
Deborah M. Siegal ◽  
Ron Movilla ◽  
Nancy Heddle ◽  
...  
Keyword(s):  
Volume Overload ◽  
Fresh Frozen Plasma ◽  
Red Blood Cell Transfusion ◽  
Cochrane Library ◽  
Increased Risk ◽  
Significant Difference ◽  
All Cause Mortality ◽  
Fresh Frozen ◽  
Warfarin Reversal ◽  
Frozen Plasma

SummaryUrgent reversal of warfarin is required for patients who experience major bleeding or require urgent surgery. Treatment options include the combination of vitamin K and coagulation factor replacement with either prothrombin complex concentrate (PCC) or fresh frozen plasma (FFP). However, the optimal reversal strategy is unclear based on clinically relevant outcomes. We searched in MEDLINE, EMBASE and Cochrane library to December 2015. Thirteen studies (5 randomised studies and 8 observational studies) were included. PCC use was associated with a significant reduction in all-cause mortality compared to FFP (OR= 0.56, 95 % CI; 0.37–0.84, p=0.006). A higher proportion of patients receiving PCC achieved haemostasis compared to those receiving FFP, but this was not statistically significant (OR 2.00, 95 % CI; 0.85–4.68). PCC use was more likely to achieve normalisation of international normalised ratio (INR) (OR 10.80, 95 % CI; 6.12–19.07) and resulted in a shorter time to INR correction (mean difference –6.50 hours, 95 %CI; –9.75 to –3.24). Red blood cell transfusion was not statistically different between the two groups (OR 0.88, 95 % CI: 0.53–1.43). Patients receiving PCC had a lower risk of post-transfusion volume overload compared to FFP (OR 0.27, 95 % CI; 0.13–0.58). There was no statistically significant difference in the risk of thromboembolism following administration of PCC or FFP (OR 0.91, 95 % CI; 0.44–1.89). In conclusion, as compared to FFP, the use of PCC for warfarin reversal was associated with a significant reduction in all-cause mortality, more rapid INR reduction, and less volume overload without an increased risk of thromboembolic events.Supplementary Material to this article is available online at www.thrombosis-online.com.

Is there a role for aggressive use of fresh frozen plasma in massive transfusion of civilian trauma patients?

2008 ◽  
Vol 196 (6) ◽  
pp. 948-960 ◽  
Author(s):  
Frederick A. Moore ◽  
Teresa Nelson ◽  
Bruce A. McKinley ◽  
Ernest E. Moore ◽  
Avery B. Nathens ◽  
...  
Keyword(s):  
Massive Transfusion ◽  
Fresh Frozen Plasma ◽  
Trauma Patients ◽  
Civilian Trauma ◽  
Fresh Frozen ◽  
Frozen Plasma

scholarly journals The effect of administration of fresh frozen plasma for trauma patients who required blood transfusion

2012 ◽  
Vol 23 (8) ◽  
pp. 342-348 ◽  
Author(s):  
Fumiaki Iwase ◽  
Tatsuho Kobayashi ◽  
Yoshibumi Miyazaki ◽  
Masahiko Maki ◽  
Kazuki Hagiwara ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Fresh Frozen Plasma ◽  
Trauma Patients ◽  
Fresh Frozen ◽  
Frozen Plasma

Out and Out It Goes . . . Where It Stops . . . Who Knows

2020 ◽  
pp. 23-32
Author(s):  
Danny Lammers ◽  
Christopher Marenco ◽  
Woo Do ◽  
John Horton
Keyword(s):  
Hemorrhagic Shock ◽  
Blood Cells ◽  
Early Recognition ◽  
Pediatric Trauma ◽  
Standard Of Care ◽  
Fresh Frozen Plasma ◽  
Trauma Patients ◽  
Packed Red Blood Cells ◽  
Fresh Frozen ◽  
Frozen Plasma

Pediatric trauma is the leading cause of death among children and adolescents. Unique variations in pediatric trauma patients require different approaches for pediatric patients than for adult patients. Early recognition of the subtle presentation of hemorrhagic shock is critical to initiate adequate resuscitation. The early use of blood transfusions is indicated for those nonresponsive to crystalloid boluses. Standard of care targets a goal of balanced administration of packed red blood cells (PRBC), fresh frozen plasma (FFP), and platelets (PLT): 1PRBC:1FFP:1PLT. Thromboelastography (TEG) and tranexamic acid (TXA) may have a role in the management of children in hemorrhagic shock.

Early Aggressive Use of Fresh Frozen Plasma Does Not Improve Outcome in Critically Injured Trauma Patients

2008 ◽  
Vol 126 ◽  
pp. 221-227 ◽  
Author(s):  
Thomas M. Scalea ◽  
Kelly M. Bochicchio ◽  
Kim Lumpkins ◽  
John R. Hess ◽  
Richard Dutton ◽  
...  
Keyword(s):  
Fresh Frozen Plasma ◽  
Trauma Patients ◽  
Improve Outcome ◽  
Fresh Frozen ◽  
Frozen Plasma
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