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Massive Transfusion Protocol

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https://www.readbyqxmd.com/read/27894500/prediction-of-massive-transfusion-in-trauma
#1
REVIEW
Paul M Cantle, Bryan A Cotton
Hemorrhage is the leading cause of preventable death in trauma. Damage control resuscitation relies on permissive hypotension, minimizing crystalloid use, and early implementation of massive transfusion protocols with established blood component ratios. These protocols improve the survival of the severely injured patient. Trauma physicians must quickly and accurately predict when a massive transfusion protocol should be activated. Several validated transfusion scores have been developed for this purpose. Many of these scores are useful for resuscitation research...
January 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/27894494/optimal-fluid-therapy-for-traumatic-hemorrhagic-shock
#2
REVIEW
Ronald Chang, John B Holcomb
The resuscitation of traumatic hemorrhagic shock has undergone a paradigm shift in the last 20 years with the advent of damage control resuscitation (DCR). Major principles of DCR include minimization of crystalloid, permissive hypotension, transfusion of a balanced ratio of blood products, and goal-directed correction of coagulopathy. In particular, plasma has replaced crystalloid as the primary means for volume expansion for traumatic hemorrhagic shock. Predicting which patient will require DCR by prompt and accurate activation of a massive transfusion protocol, however, remains a challenge...
January 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/27850802/1165-massive-transfusion-protocol-in-a-community-nontrauma-setting-is-blood-product-wastage-avoidable
#3
Noubar Kevorkian, Sharon Weintraub, Nancy Bienkowski, Peg Basch, Stacy Pagliaruli, Susan Parker, Jacobs Barry, Rekha Singh
No abstract text is available yet for this article.
December 2016: Critical Care Medicine
https://www.readbyqxmd.com/read/27805995/rapid-thrombelastography-r-teg-thresholds-for-goal-directed-resuscitation-of-patients-at-risk-for-massive-transfusion
#4
Peter M Einersen, Ernest E Moore, Michael P Chapman, Hunter B Moore, Eduardo Gonzalez, Christopher C Silliman, Anirban Banerjee, Angela Sauaia
BACKGROUND: Uncontrolled hemorrhage is a leading cause of mortality following trauma accounting for up to 40% of deaths. Massive transfusion protocols (MTPs) offer a proven benefit in resuscitation of these patients. Recently, the superiority of thrombelastography (TEG)-guided resuscitation over strategies guided by conventional clotting assays (CCA) has been established. We seek to determine optimal thresholds for r-TEG driven resuscitation. METHODS: R-TEG data were reviewed for 190 patients presenting to our Level 1 Trauma Center from 2010 to 2015...
October 31, 2016: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/27779982/impact-of-massive-transfusion-and-aging-blood-in-acute-trauma
#5
Tanya Anand, Rajesh Ramnanan, Ruby Skinner, Maureen Martin
Blood transfusions cause altered immunity and the duration of storage is contributory. In the era of massive transfusion protocols (MTPs) this impact is unclear, particularly as it relates to balanced transfusions. Trauma patients requiring our MTP after admission to our Level II trauma center were studied. The average age of blood transfused was calculated; old blood was a storage time of ≥14 days versus new blood <14 days. Blood to plasma ratios of 1:1 were compared with ratios >1:1. Infections, organ dysfunction multiorgan injury (MOI), and death were compared based on ratios and blood storage times...
October 2016: American Surgeon
https://www.readbyqxmd.com/read/27774614/blood-component-transfusion-and-wastage-rates-in-the-setting-of-massive-transfusion-in-three-regional-trauma-centers
#6
Nancy M Dunbar, Nicholas J Olson, Zbigniew M Szczepiorkowski, Eric D Martin, Ryan M Tysarcyk, Darrell J Triulzi, Louis H Alarcon, Mark H Yazer
BACKGROUND: The purpose of massive transfusion protocols (MTPs) is to provide large quantities of blood products rapidly to exsanguinating patients. The expected rates of blood product transfusion and wastage in this setting have not been defined. This study was undertaken to assess the transfusion and wastage rates for bleeding patients requiring emergency issue of blood components at three American Level I trauma centers. STUDY DESIGN AND METHODS: Three hospitals participated, all of which are Level I trauma centers that have MTPs in place where uncrossmatched red blood cells (RBCs) can be ordered with or without platelets (PLTs), plasma, and cryoprecipitate...
October 23, 2016: Transfusion
https://www.readbyqxmd.com/read/27773215/review-of-a-paediatric-massive-transfusion-protocol-in-a-children-hospital
#7
Koh Mee Zhen, Saretta Sng, Raymond Fu
No abstract text is available yet for this article.
February 2016: Pathology
https://www.readbyqxmd.com/read/27755062/amniotic-fluid-embolism
#8
Courtney Stanley Sundin, Lauren Bradham Mazac
Amniotic fluid embolism (AFE) is a rare but serious and potentially deadly complication of pregnancy that is unpreventable and unpredictable. Most AFE events occur during labor; however, approximately one third happen during the immediate postpartum period. Presentation is abrupt and thought to be an abnormal response to fetal materials entering maternal circulation through the placental insertion site. Care providers must recognize the signs and symptoms of AFE and react quickly in effort to treat potential complications...
October 13, 2016: MCN. the American Journal of Maternal Child Nursing
https://www.readbyqxmd.com/read/27749352/massive-transfusion-protocols-a-survey-of-academic-medical-centers-in-the-united-states
#9
Angela B Treml, Jed B Gorlin, Richard P Dutton, Barbara M Scavone
BACKGROUND: Massive transfusion protocols (MTPs) have been adopted in many hospitals, and they may improve outcomes, as well as decrease the number of blood products transfused. However, there are no specific guidelines regarding the number and types of products that should be included in these protocols. MTPs may vary from hospital to hospital. METHODS: A short, web-based survey was sent to blood bank medical directors at academic institutions to learn details about MTPs...
October 3, 2016: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/27699730/management-of-coagulopathy-in-postpartum-hemorrhage
#10
Andra H James, Chad Grotegut, Homa Ahmadzia, Cathleen Peterson-Layne, Evelyn Lockhart
The purpose of this article is to review the use of blood products and hemostatic agents in the management of coagulopathy at the time of postpartum hemorrhage. Blood product administration strategies are broadly reviewed, including the role of the blood bank, the role of massive transfusion protocols, the role of laboratory monitoring, and the role of anesthesia management. Aspects of patient blood management are discussed. The concept refers to an evidence-based, comprehensive, multidisciplinary approach to optimizing the care of patients who might need transfusion and includes measures to avoid or minimize transfusion such as preoperative anemia management, cell salvage, and the use of hemostatic medication to reduce bleeding...
October 3, 2016: Seminars in Thrombosis and Hemostasis
https://www.readbyqxmd.com/read/27636575/targeted-coagulation-management-in-severe-trauma-the-controversies-and-the-evidence
#11
James Winearls, Michael Reade, Helen Miles, Andrew Bulmer, Don Campbell, Klaus Görlinger, John F Fraser
Hemorrhage in the setting of severe trauma is a leading cause of death worldwide. The pathophysiology of hemorrhage and coagulopathy in severe trauma is complex and remains poorly understood. Most clinicians currently treating trauma patients acknowledge the presence of a coagulopathy unique to trauma patients-trauma-induced coagulopathy (TIC)-independently associated with increased mortality. The complexity and incomplete understanding of TIC has resulted in significant controversy regarding optimum management...
October 2016: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/27592155/major-obstetric-hemorrhage
#12
A Le Gouez, F J Mercier
Major obstetric hemorrhage is a challenge for anesthesiologists because it remains responsible for over 10% of maternal deaths in high-income countries. A standardized multidisciplinary management, described in locally validated protocols and based on international guidelines is mandatory to prevent these deaths. The first difficulty relies on the systematic underestimation of the bleeding. Collection bags must be used to facilitate the diagnosis and therefore rapid management. The etiologies in antenatal or postpartum must be well-known in order to be treated adequately...
August 31, 2016: Transfusion Clinique et Biologique: Journal de la Société Française de Transfusion Sanguine
https://www.readbyqxmd.com/read/27572499/the-effect-of-massive-transfusion-protocol-implementation-on-pediatric-trauma-care
#13
Ruth S Hwu, Philip C Spinella, Martin S Keller, David Baker, Michael Wallendorf, Julie C Leonard
BACKGROUND: Massive transfusion protocols (MTPs) to address hemorrhage are understudied in children. The objective was to determine the effect of MTP implementation on outcomes of injured children. STUDY DESIGN AND METHODS: This was a retrospective comparison of injured children before and after MTP implementation for children less than 18 years old who presented in 2005 to 2014 and received red blood cells (RBCs) within 24 hours of arrival. Children were divided into groups based on pre-/post-MTP implementation and subgrouped based on receipt of massive transfusion (≥40 mL/kg RBCs or ≥80 mL/kg total blood products at 24 hr from arrival)...
August 29, 2016: Transfusion
https://www.readbyqxmd.com/read/27533313/adult-based-massive-transfusion-protocol-activation-criteria-do-not-work-in-children
#14
Shannon N Acker, Brianne Hall, Lauren Hill, David A Partrick, Denis D Bensard
Introduction In the adult population, assessment of blood consumption (ABC) score [penetrating mechanism, positive focused assessment sonography for trauma (FAST), systolic blood pressure < 90, and heart rate (HR) > 120] ≥2 identifies trauma patients who require massive transfusion (MT) with sensitivity and specificity of 75 and 86%. We hypothesized that the adult criteria cannot be applied to children, as the vital sign cut-offs are not age-adjusted. We aimed to determine if the use of a shock index, pediatric age-adjusted (SIPA) would improve the discriminate ability of the ABC score in children...
August 17, 2016: European Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/27515056/the-confusion-continues-results-from-an-american-association-for-the-surgery-of-trauma-survey-on-massive-transfusion-practices-among-united-states-trauma-centers
#15
Eric Etchill, Jason Sperry, Brian Zuckerbraun, Louis Alarcon, Joshua Brown, Kevin Schuster, Lewis Kaplan, Greta Piper, Andrew Peitzman, Matthew D Neal
BACKGROUND: Massive transfusion practices have undergone several recent developments. We sought to examine institutional practices guiding hemostatic resuscitation in the setting of massive hemorrhage. STUDY DESIGN AND METHODS: A 37-question online survey was sent to American Association for the Surgery of Trauma members. RESULTS: A total of 191 surgeons from 125 institutions completed the survey. Level I and II centers composed 70 and 18% of responding sites, respectively...
October 2016: Transfusion
https://www.readbyqxmd.com/read/27510718/massive-transfusion-protocol-%C3%A2-communication-ordering-practice-survey-mtp-cops
#16
Minh-Ha Tran, Sarah Vossoughi, Sarah Harm, Nancy Dunbar, Mark Fung
OBJECTIVES: We sought to assess ordering practices and quality of communication during massive transfusion at US level I trauma centers. METHODS: An anonymous, web-based survey was distributed to blood banks supporting US level I trauma centers. Information gathered in the survey included demographics, utilization of and perceived level of support for computerized physician order entry (CPOE), frequency of order confusion, and nonprotocol ordering. Responses were analyzed using descriptive statistics...
September 2016: American Journal of Clinical Pathology
https://www.readbyqxmd.com/read/27457858/what-s-in-the-box-the-effectiveness-of-a-low-volume-massive-transfusion-protocol
#17
Katherine Baysinger, Merry E Barnett, Mickey Ott, William Bromberg, Katherine Mcbride, Lynne Thompson, Gretchen Goodman, Eric Shaw, James Dunne
Transfusion ratios approaching 1:1:1 of packed red blood cells (PRBCs) to fresh frozen plasma (FFP) to platelet have been shown to improve outcomes in trauma. There is little data available to describe in what quantity that ratio should be delivered. We hypothesized that lowering the total volume of products delivered in each protocol round would not adversely affect outcomes in the bleeding trauma patient. A retrospective review of 9732 trauma patients admitted to a rural Level I trauma center over a 3-year period was performed...
July 2016: American Surgeon
https://www.readbyqxmd.com/read/27425576/implementation-of-a-management-protocol-for-massive-bleeding-reduces-mortality-in-non-trauma-patients-results-from-a-single-centre-audit
#18
N Martínez-Calle, F Hidalgo, A Alfonso, M Muñoz, M Hernández, R Lecumberri, J A Páramo
OBJECTIVE: To audit the impact upon mortality of a massive bleeding management protocol (MBP) implemented in our center since 2007. DESIGN: A retrospective, single-center study was carried out. Patients transfused after MBP implementation (2007-2012, Group 2) were compared with a historical cohort (2005-2006, Group 1). BACKGROUND: Massive bleeding is associated to high mortality rates. Available MBPs are designed for trauma patients, whereas specific recommendations in the medical/surgical settings are scarce...
July 14, 2016: Medicina Intensiva
https://www.readbyqxmd.com/read/27389129/bundles-of-care-for-resuscitation-from-hemorrhagic-shock-and-severe-brain-injury-in-trauma-patients-translating-knowledge-into-practice
#19
Shahid Shafi, Ashley W Collinsworth, Kathleen M Richter, Hasan B Alam, Lance B Becker, Malcolm R Bullock, James M Ecklund, John Gallagher, Raj Gandhi, Elliott R Haut, Zachary L Hickman, Heidi Hotz, James McCarthy, Alex B Valadka, John Weigelt, John B Holcomb
No abstract text is available yet for this article.
October 2016: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/27381816/bicarbonate-and-mannitol-treatment-for-traumatic-rhabdomyolysis-revisited
#20
Jamison S Nielsen, Mitchell Sally, Richard J Mullins, Matthew Slater, Tahnee Groat, Xiang Gao, J Salvador de la Cruz, Margaret K M Ellis, Martin Schreiber, Darren J Malinoski
BACKGROUND: A rhabdomyolysis protocol (RP) with mannitol and bicarbonate to prevent acute renal dysfunction (ARD, creatinine >2.0 mg/dL) remains controversial. METHODS: Patients with creatine kinase (CK) greater than 2,000 U/L over a 10-year period were identified. Shock, Injury Severity Score, massive transfusion, intravenous contrast exposure, and RP use were evaluated. RP was initiated for a CK greater than 10,000 U/L (first half of the study) or greater than 20,000 U/L (second half)...
June 14, 2016: American Journal of Surgery
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