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Not only in trauma patients: hospital-wide implementation of a massive transfusion protocol. Transfus Med 2014 Jun;24(3):162-8

Date

01/01/2014

Pubmed ID

24372790

Pubmed Central ID

PMC4043857

DOI

10.1111/tme.12096

Scopus ID

2-s2.0-84901493973   32 Citations

Abstract

OBJECTIVES: To review outcomes of massive transfusion protocol (MTP) activation and determine the impact of MTP implementation on blood bank use.

BACKGROUND: MTP has been established to rapidly provide plasma and packed red blood cells in ratios approaching 1 : 1. Due to availability, MTP has been utilised in non-traumatic haemorrhage despite evidence of benefit in this population. Our hospital-wide implementation of MTP was reviewed for propriety, outcomes and effect on blood bank resources.

METHODS: Retrospective cohort study of patients receiving transfusion after MTP activation from October 2009 to 2011. Underlying medical conditions and baseline medication use were determined. In-hospital and 24-h mortality were compared with evaluation for confounding by Acute Physiology And Chronic Health Evaluation (APACHE) score and duration of MTP activation. Blood product use before and after MTP implementation was reviewed.

RESULTS: MTP activation occurred in 62 trauma and 63 non-trauma patients. Non-trauma patients were older, had more underlying medical conditions and higher APACHE scores compared with trauma patients; 24-h mortality was higher in trauma compared with non-trauma patients (27·4 vs 11·1%, P = 0·02). There was no significant difference of in-hospital mortality. Transfusion ratio did not differ between trauma and non-trauma patients and was not associated with mortality even when MTP activation duration and APACHE score were considered. Hospital-wide blood product use did not change with MTP implementation.

CONCLUSIONS: MTP may be successfully used in trauma and non-trauma settings without significantly impacting overall blood product utilisation. Inclusion of non-trauma patients into prospective studies of resuscitation with blood products is warranted to ensure benefit in these patients.

Author List

Baumann Kreuziger LM, Morton CT, Subramanian AT, Anderson CP, Dries DJ

Author

Lisa M. Baumann Kreuziger MD Associate Professor in the Medicine department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Blood Banks
Blood Transfusion
Guideline Adherence
Hemorrhage
Hospitals
Humans
Male
Practice Guidelines as Topic
Wounds and Injuries