Massive Transfusion Protocols in Trauma Care

doi:10.1017/CBO9780511547447.010

7 - Massive Transfusion Protocols in Trauma Care

Published online by Cambridge University Press: 18 January 2010

John E. Forestner

Edited by

Charles E. Smith

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John E. Forestner: Affiliation:
Department of Anesthesiology and Pain Management, Parkland Memorial Hospital, University of Texas Southwestern Medical School, Dallas, Texas
Charles E. Smith: Affiliation:
Case Western Reserve University, Ohio

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Summary

Objectives

Describe planning and implementation of a massive transfusion protocol (MTP) for a large urban trauma service.
Stress the coordination and education effort involving many hospital services prior to introduction of the protocol.
Review the available data on clotting function during rapid exsanguination, and the optimal distribution of blood products for fluid resuscitation (packed red blood cells, plasma, platelets, cryoprecipitate, and recombinant Factor VIIa) during ongoing blood loss.
Discuss the difficulty of designing research in trauma patients to demonstrate significant benefit to these patients caused by the MTP.
Present preliminary outcome data using the MTP (compared with prospectively gathered historical control data collected in the year prior to introduction of the MTP), which shows a decrease in the number of blood products required for fluid resuscitation in surgery, implying some benefit in trauma patients by providing control of coagulopathy.

INTRODUCTION

The design and implementation of a massive transfusion protocol (MTP) for use in trauma care in a large urban hospital is described. The MTP provides rapidly bleeding patients with automatic regular shipments of blood products to facilitate fluid resuscitation during emergency care and surgery. Design of the protocol, particularly the choice of ratio between packed red blood cells, plasma, and platelets at each stage of resuscitation, is discussed based on results of recent studies concerning the need for volume support, oxygen delivery, and coagulation support during ongoing blood loss and surgery.

Type: Chapter
Information: Trauma Anesthesia , pp. 121 - 132

DOI: https://doi.org/10.1017/CBO9780511547447.010 [Opens in a new window]

Publisher: Cambridge University Press

Print publication year: 2008

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References

Holcomb, JG, Hess, JR. Early massive trauma transfusion: State of the art. Editors' introduction. J Trauma 2006;60:S1–2. Symposium, S1–96.CrossRef Google Scholar

Dutton, RP, Carson, JL. Indications for early red blood cell transfusion. J Trauma 2006;60:S35–40.CrossRef Google Scholar PubMed

Kauvar, DS, Lefering, R, Wade, CE. Impact of hemorrhage on trauma outcome: An overview of epidemiology, clinical presentations, and therapeutic considerations. J Trauma 2006;60: S3–11.CrossRef Google Scholar PubMed

Repine, TB, Perkins, JG, Kauvar, DS, Blackborne, L. The use of fresh whole blood in massive transfusion. J Trauma 2006;60:S59–69.CrossRef Google Scholar PubMed

Malone, DL, Dunne, J, Tracy, JK, Putnam, AT, Scalea, TM, Napolitano, LM. Blood transfusion, independent of shock severity, is associated with worse outcome in trauma. J Trauma 2003;54: 898–905; discussion 905–7.CrossRef Google Scholar PubMed

Norda, R, Tynell, E, Akerblom, O. Cumulative risks of early fresh frozen plasma, cryoprecipitate and platelet transfusion in Europe. J Trauma 2006;60:S41–5.CrossRef Google Scholar

Holcomb, JG. Impact of hemorrhage on trauma outcome: An overview of epidemiology, clinical presentations, and therapeutic considerations. J Trauma 2006;60:discussion S11.Google Scholar

Hardy, J-F, Moerloose, P, Samama, M. Massive transfusion and coagulopathy: Pathophysiology and implications for clinical management. Can J Anesth 2004;51:293–310.CrossRef Google Scholar PubMed

Murray, DJ, Pernell, BJ, Weinstein, SL, Olson, JD. Packed red blood cells in acute blood loss: Dilutional coagulopathy as cause of surgical bleeding. Anesth Analg 1995;80:336–42.Google Scholar PubMed

Hampton S. Personal communication.

Martinowitz, U. Impact of hemorrhage on trauma outcome: An overview of epidemiology, clinical presentations, and therapeutic considerations. J Trauma 2006;60:discussion S11.Google Scholar

Hirshberg, A, Dugas, M, Banez, EI, Scott, BG, Wall, MJ Jr, Mattox, KL. Minimizing dilutional coagulopathy in exsanguinating hemorrhage: A computer simulation. J Trauma 2003;54: 454–63.CrossRef Google Scholar PubMed

Hiippala, ST, Myllyla, GJ, Vahtera, E. Hemostatic factors and replacement of major blood loss with plasma-poor red cell concentrates. Anesth Analg 1995;81:360–5.Google Scholar PubMed

Ketchum, L, Hess, JR, Hiippala, ST. Indications for early fresh frozen plasma, cryoprecipitate, and platelet transfusion in trauma. J Trauma 2006;60:S51–8.CrossRef Google Scholar PubMed

Malone, DL, Hess, JR, Fingerhut, A. Massive transfusion practices around the globe and a suggestion for a common massive transfusion protocol. J Trauma 2006;60:S91–6.CrossRef Google Scholar

Haas, T, Innerhofer, P, Kuhbacher, G, Fries, D. Novoseven for treatment of coagulopathy. Anesthesiology 2005;100:54–8.Google Scholar

Dutton, RP, McCunn, M, Hyder, M, et al. Factor VIIa for correction of traumatic coagulopathy. J Trauma 2004;57:709–9.CrossRef Google Scholar PubMed

Allen, GA, Hoffman, M, Roberts, HR, Monroe, DM III. Recombinant activated factor VII: Its mechanism of action and role in the control of hemorrhage. Can J Anesth 2002;49:S7–14.Google Scholar PubMed