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- Effects of Massive Transfusion Protocol Implementation in Trauma Patients at a Level I Trauma Center
- Hyun Woo Sun, Sang Bong Lee, Sung Jin Park, Chan Ik Park, Jae Hun Kim
- J Trauma Inj. 2020;33(2):74-80. Published online June 30, 2020
- DOI: https://doi.org/10.20408/jti.2020.022
- 5,841 View
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- 1 Citations
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Abstract
PDF Purpose This study was conducted to investigate whether rapid and efficient administration of blood products was achieved and whether clinical outcomes were improved by applying a massive transfusion protocol (MTP).
Methods From January 2016 to September 2019, the medical records of trauma patients who received at least 10 units of packed red blood cells (PRBC) at Pusan National University Hospital (level I trauma center) were retrospectively reviewed. The patients treated from January 2016 to January 2018 were designated as the non-MTP group, and those treated from February 2018 to September 2019 were designated as the MTP group.
Results During the study period, 370 patients received massive transfusions. The non-MTP and MTP groups comprised 84 and 55 patients, respectively. No significant between-group differences were found in the units of PRBC (23.2 vs. 25.3, respectively;
p =0.46), fresh frozen plasma (FFP) (21.1 vs. 24.4, respectively;p =0.40), and platelets (PLT) (15.4 vs. 17.0, respectively;p =0.54) administered in the first 24 hours. No statistically significant differences between the non-MTP and MTP groups were found in the FFP-to-PRBC ratio (0.9 vs. 0.94, respectively;p =0.44) and or the PLT-to-PRBC ratio (0.72 vs. 0.72, respectively;p =0.21). However, the total number of cryoprecipitate units was significantly higher in the MTP group than in the non-MTP group (7.4 vs. 15.3 units, respectively;p =0.003) and the ratio of cryoprecipitate to PRBC in the MTP group was significantly higher than in the non-MTP group (0.31 vs. 0.62, respectively;p =0.021). The time to transfusion was significantly reduced after MTP implementation (41.0 vs. 14.9 minutes, respectively;p =0.003).Conclusions Although no significant differences were found in the clinical outcomes of patients who had undergone severe trauma, rapid and balanced transfusion was achieved after implementing the MTP.
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Citations
Citations to this article as recorded by
- Acquired Factor XIII Deficiency in Patients with Multiple Trauma
Michael Hetz, Tareq Juratli, Oliver Tiebel, Moritz Tobias Giesecke, Serafeim Tsitsilonis, Hanns-Christoph Held, Franziska Beyer, Christian Kleber
Injury.2023; 54(5): 1257. CrossRef
Case Report- Application of Extracorporeal Membranous Oxygenation in Trauma Patient with Possible Transfusion Related Acute Lung Injury (TRALI)
- Dae Sang Lee, Chi Min Park
- J Trauma Inj. 2015;28(1):34-38. Published online March 30, 2015
- DOI: https://doi.org/10.20408/jti.2015.28.1.34
- 1,712 View
- 5 Download
- 1 Citations
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Abstract
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- The case of a patient with a transfusion-related acute lung injury (TRALI) to whom extracorporeal membrane oxygenation (ECMO) had been applied is reported. A 55-year-old male injured with liver laceration (grade 3) without chest injury after car accident. He received lots of blood transfusion and underwent damage control abdominal surgery. In the immediate postoperative period, he suffered from severe hypoxia and respiratory acidosis despite of vigorous management such as 100% oxygen with mechanical ventilation, high PEEP and muscle relaxant. Finally, ECMO was applied to the patients as a last resort. Aggressive treatment with ECMO improved the oxygenation and reduced the acidosis. Unfortunately, the patient died of liver failure and infection. TRALI is a part of acute respiratory distress syndrome (ARDS). The use of ECMO for TRALI induced severe hypoxemia might be a useful option for providing time to allow the injured lung to recover.
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Summary
Citations
Citations to this article as recorded by- A Case Report of Transfusion-Related Acute Lung Injury Induced in the Patient with HLA Antibody after Fresh Frozen Plasma Transfusion
Ki Sul Chang, Dae Won Jun, Youngil Kim, Hyunwoo Oh, Min Koo Kang, Junghoon Lee, Intae Moon
The Korean Journal of Blood Transfusion.2015; 26(3): 309. CrossRef
Original Articles- Predictive Factors of Blood Transfusion Requirement in Blunt Trauma Patients Admitted to the Emergency Room
- Ji Sun Oh, Hyung Min Kim, Se Min Choi, Kyoung Ho Choi, Tai Yong Hong, Kyu Nam Park, Byung Hak So
- J Korean Soc Traumatol. 2009;22(2):218-226.
- 1,122 View
- 3 Download
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Abstract
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- PURPOSE
In multiple blunt trauma patients, transfusion may be a significant therapeutic adjunct to non-operative management. The blood products must be expedited and efficiently to patients in impending shock caused by hemorrhage or traumatic coagulopathy, but the decision to perform blood transfusion has been made empirically, based on the clinician's and has not been guided by objective parameters, but own opinion, that may result in an underestimate of or a failure to detect bleeding, in delayed transfusion, and in a reduced outcome. This article presents quickly assessable predictive factors for determining if a blood transfusion is required to improve outcomes in multiple blunt trauma patients admitted to the emergency room.
METHODS
In a retrospective review of 282 multiple blunt trauma patients who visited our emergency center by emergency rescuer during a 1-year period, possible factors predictive of the need for a blood transfusion were subjected to univariate and multivariate logistic regression analysis.
RESULTS
Of blunt trauma patients ,9.2% (26/282), received red blood cells in the first 24 hours of care. Univariate analysis revealed significant associations between blood transfused and heart rate (HR) > 100 beats/min, respiratory rate (RR) > 20 breaths/min, Glasgow Coma Scale (GCS) < 14, Revised Trauma Score (RTS) < 11, white blood cell count (WBC) < 4000 or > 10000, and initial abnormal portable trauma series (Cspine lateral, chest AP, pelvis AP). A multiple regression analysis, with a correction for diagnosis, identified HR > 100 beats/min (EXP 3.2), GCS < 14 (EXP 4.1), and abnormal trauma series (EXP 2.9), as independent predictors.
CONCLUSION
In our study, systolic blood pressure (SBP) < 90 mmHg, old age > 65 years, hemoglobin < 13g/dL, mechanism of injury were poor predictors of early blood transfusion. Initial abnormal portable trauma series, HR > 100 beats/min, and GCS < 14 were quickly assessable useful factors for predicting a need for early blood transfusion in blunt trauma patients visiting the emergency room. -
Summary
- Validity of Transfusing Group O+ Unmatched Packed Red Blood Cells in Hemorrhagic Shock Patients
- Ji Hwan Lee, Minhong Choa, Junho Cho, Sung Pil Chung
- J Korean Soc Traumatol. 2009;22(2):167-171.
- 1,172 View
- 1 Download
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Abstract
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- PURPOSE
It is important to begin a transfusion safely and appropriately as soon as possible in a hemorrhagic shock patient. A group O+ unmatched pack red blood cell (universal O+) transfusion may satisfy that requirement. We report our experiences with universal O+ to compare its usefulness for hemorrhagic shock patients with that of a matched pack red blood cell transfusion in the emergency department (ED).
METHODS
This is a retrospective study. Patients who had systolic blood pressure of less than 90 mmHg or a pulse rate of more than 120 beats per minute in the ED were included, and their medical records were reviewed. The collected data were demographic data, vital signs, blood test results, time to transfusion, the amount of transfusion, complications, and diagnoses. We calculated the emergency transfusion score (ETS) based on the patients' medical records.
RESULTS
Two hundred thirty-five patients were included. Forty-eight patients (36 trauma and 12 non-trauma patients) were transfused with a universal O+. These patients had less time to transfusion compared with the cross-matched transfusion groups (35+/-42 versus 170+/-187 minutes, p<0.001). There were no differences in complications between groups (p=0.076). Of the patients who were transfused with universal O+, 94.4% got more than 3 ETS.
CONCLUSION
The universal O+ transfusion, compared with matched pack red blood cell transfusion, should be a useful treatment for ED hemorrhagic shock patient due to its having a shorter time to transfusion without an increase in complications. -
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