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Ten‐year evolution of a massive transfusion protocol in a level 1 trauma centre: have outcomes improved?
Author(s) -
Meij Jessica E.,
Geeraedts Jr Leo M. G.,
Kamphuis Saskia J. M.,
Kumar Nimmi,
Greenfield Tony,
Tweeddale Geoff,
Rosenfeld David,
D'Amours Scott K.
Publication year - 2019
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.15416
Subject(s) - medicine , intensive care unit , incidence (geometry) , injury severity score , resuscitation , major trauma , retrospective cohort study , packed red blood cells , blood transfusion , emergency medicine , surgery , poison control , injury prevention , physics , optics
Background We aimed to evaluate the evolution and implementation of the massive transfusion protocol (MTP) in an urban level 1 trauma centre. Most data on this topic comes from trauma centres with high exposure to life‐threatening haemorrhage. This study examines the effect of the introduction of an MTP in an Australian level 1 trauma centre. Methods A retrospective study of prospectively collected data was performed over a 14‐year period. Three groups of trauma patients, who received more than 10 units of packed red blood cells (PRBC), were compared: a pre‐MTP group (2002–2006), an MTP‐I group (2006–2010) and an MTP‐II group (2010–2016) when the protocol was updated. Key outcomes were mortality, complications and number of blood products transfused. Results A total of 168 patients were included: 54 pre‐MTP patients were compared to 47 MTP‐I and 67 MTP‐II patients. In the MTP‐II group, fewer units of PRBC and platelets were administered within the first 24 h: 17 versus 14 ( P = 0.01) and 12 versus 8 ( P < 0.001), respectively. Less infections were noted in the MTP‐I group: 51.9% versus 31.9% ( P = 0.04). No significant differences were found regarding mortality, ventilator days, intensive care unit and total hospital lengths of stay. Conclusion Introduction of an MTP‐II in our level 1 civilian trauma centre significantly reduced the amount of PRBC and platelets used during damage control resuscitation. Introduction of the MTP did not directly impact survival or the incidence of complications. Nevertheless, this study reflects the complexity of real‐life medical care in a level 1 civilian trauma centre.