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Massive Transfusion Protocol

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https://www.readbyqxmd.com/read/29123874/early-administration-of-fibrinogen-concentrates-improves-the-short-term-outcomes-of-severe-pelvic-fracture-patients
#1
Koichi Inokuchi, Makoto Sawano, Koji Yamamoto, Atsushi Yamaguchi, Satoru Sugiyama
Aim: Hemorrhage from pelvic fracture is a major cause of mortality after blunt trauma. Several studies have suggested that early fibrinogen supplementation improves outcomes of traumatic hemorrhage. Thus, we revised our massive transfusion protocol (MTP) in April 2013 to include early off-label administration of fibrinogen concentrate. The objective of this study was to evaluate the impact of the revision on the short-term outcomes of pelvic fracture patients. Methods: This was a single-center, retrospective, cohort study...
July 2017: Acute Medicine & Surgery
https://www.readbyqxmd.com/read/29047413/itactic-implementing-treatment-algorithms-for-the-correction-of-trauma-induced-coagulopathy-study-protocol-for-a-multicentre-randomised-controlled-trial
#2
Kjersti Baksaas-Aasen, Lewis Gall, Simon Eaglestone, Claire Rourke, Nicole P Juffermans, J Carel Goslings, Paal Aksel Naess, Susan van Dieren, Sisse Rye Ostrowski, Jakob Stensballe, Marc Maegele, Simon J Stanworth, Christine Gaarder, Karim Brohi, Per I Johansson
BACKGROUND: Traumatic injury is the fourth leading cause of death globally. Half of all trauma deaths are due to bleeding and most of these will occur within 6 h of injury. Haemorrhagic shock following injury has been shown to induce a clotting dysfunction within minutes, and this early trauma-induced coagulopathy (TIC) may exacerbate bleeding and is associated with higher mortality and morbidity. In spite of improved resuscitation strategies over the last decade, current transfusion therapy still fails to correct TIC during ongoing haemorrhage and evidence for the optimal management of bleeding trauma patients is lacking...
October 18, 2017: Trials
https://www.readbyqxmd.com/read/29023857/preceding-haemorrhagic-shock-as-a-detrimental-risk-factor-for-respiratory-distress-after-excessive-allogeneic-blood-transfusion
#3
R Masuda, T Iijima, R Kondo, Y Itoda, M Matsuhashi, S Hashimoto, T Kohira, N Kobayashi, H Okazaki
BACKGROUND AND OBJECTIVES: Whether transfusion-associated circulatory overload arises as a simple result of over-transfusion or requires another trigger remains unclear. Here, we examined whether respiratory distress could be reproduced by massive transfusion alone in an animal model. MATERIALS AND METHODS: A total of 20 anaesthetized swine were equipped with monitors. Allogeneic blood was obtained from 10 donor swine. A 4-stage loading protocol with each stage equivalent to 25% of the blood volume (BV) in the recipient swine was then used to infuse crystalloid (CR), hydroxyethyl starch (HES) or allogeneic blood (TR) (n = 5 each)...
October 11, 2017: Vox Sanguinis
https://www.readbyqxmd.com/read/29017765/accuracy-of-shock-index-versus-abc-score-to-predict-need-for-massive-transfusion-in-trauma-patients
#4
Rebecca Schroll, David Swift, Danielle Tatum, Stuart Couch, Jiselle B Heaney, Monica Llado-Farrulla, Shana Zucker, Frances Gill, Griffin Brown, Nicholas Buffin, Juan Duchesne
BACKGROUND: Various scoring systems have been developed to predict need for massive transfusion in traumatically injured patients. Assessments of Blood Consumption (ABC) score and Shock Index (SI) have been shown to be reliable predictors for Massive Transfusion Protocol (MTP) activation. However, no study has directly compared these two scoring systems to determine which is a better predictor for MTP activation. The primary objective was to determine whether ABC or SI better predicted the need for MTP in adult trauma patients with severe hemorrhage...
September 15, 2017: Injury
https://www.readbyqxmd.com/read/28985912/patterns-of-vasopressor-utilization-during-the-resuscitation-of-massively-transfused-trauma-patients
#5
Galinos Barmparas, Navpreet K Dhillon, Eric Jt Smith, Russell Mason, Nicolas Melo, Gretchen M Thomsen, Daniel R Margulies, Eric J Ley
BACKGROUND: The use of vasopressors (VP) in the resuscitation of massively transfused trauma patients might be considered a marker of inadequate resuscitation. We sought to characterize the utilization of VP in patients receiving massive transfusion and examine the association of their use with mortality. METHODS: Trauma patients admitted from January 2011 to October 2016 receiving massive transfusion, defined as 3 units of pRBC within the first hour from admission, were selected for analysis...
September 27, 2017: Injury
https://www.readbyqxmd.com/read/28958369/balanced-resuscitation-in-trauma-management
#6
REVIEW
Paul M Cantle, Bryan A Cotton
Over the past decade substantial knowledge has been gained in understanding both the coagulopathy of trauma and the complications associated with aggressive crystalloid-based resuscitation. Balanced resuscitation, which includes permissive hypotension, limiting crystalloid use, and the transfusion of blood products in ratios similar to whole blood, has changed the previous standard of care. Prompt initiation of massive transfusion and the protocolled use of 1:1:1 product ratios have improved the morbidity and mortality of patients with trauma in hemorrhagic shock...
October 2017: Surgical Clinics of North America
https://www.readbyqxmd.com/read/28953556/uncontrolled-bleeding-of-the-gastrointestinal-tract
#7
Alain D'Hondt, Lionel Haentjens, Nicolas Brassart, Frédéric Flamme, Jean-Charles Preiser
PURPOSE OF REVIEW: Acute gastrointestinal bleeding is a frequent emergency situation, whose incidence will likely rise as a result of the increasing use of direct anticoagulants and of the medical progresses resulting in longer life expectancy with underlying comorbidities. Updated guidelines and improvements in the diagnostic and therapeutic tools are now available and will likely improve the management of massive gastrointestinal bleeding in the near future. RECENT FINDINGS: The assessment of severity has been improved by validated scores useable upon admission...
December 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/28930957/clot-dynamics-and-mortality-the-ma-r-ratio
#8
Stephanie A Savage, Ben L Zarzaur, Timothy H Pohlman, Brian L Brewer, Louis J Magnotti, Martin A Croce, Garrett H Lim, Ali C Martin
INTRODUCTION: The coagulopathy of trauma, illustrated by a short R-time, is common and well understood. The physiology behind this may be early thrombin burst with rapid clot formation. Rapid consumption of fibrinogen, however, may result in weak clot and substrate depletion, resulting in low MA. While these characteristics are interesting, utilizing thromboelastography (TEG) to identify those at risk of subsequent bleeding diathesis, especially in those who do not demonstrate early signs of physiologic derangement, is challenging...
October 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28885411/improvement-in-outcomes-of-major-obstetric-hemorrhage-through-systematic-change
#9
Daniel W Skupski, David Brady, Isaac P Lowenwirt, Jason Sample, Stephanie N Lin, Rahul Lohana, Gary S Eglinton
OBJECTIVE: To report the outcomes over 14 years of sustained systematic institutional focus on the care of women with major obstetric hemorrhage, defined as estimated blood loss greater than 1,500 mL. METHODS: A retrospective cohort study of women with major obstetric hemorrhage at our hospital from 2000 to 2014 compares baseline conditions (age, multiparity, prior cesarean delivery, morbidly adherent placenta), morbidity (lowest mean temperature, lowest mean pH, coagulopathy, hysterectomy), and mortality among three time periods (period 1=January 2000 to December 2001, period 2=January 2002 to August 2005, period 3=September 2005 to December 2014)...
October 2017: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28857793/initiation-and-termination-of-massive-transfusion-protocols-current-strategies-and-future-prospects
#10
John C Foster, Joshua W Sappenfield, Robert S Smith, Sean P Kiley
The advent of massive transfusion protocols (MTP) has had a significant positive impact on hemorrhaging trauma patient morbidity and mortality. Nevertheless, societal MTP guidelines and individual MTPs at academic institutions continue to circulate opposing recommendations on topics critical to MTPs. This narrative review discusses up-to-date information on 2 such topics, the initiation and termination of an MTP. The discussion for each begins with a review of the recommendations and supporting literature presented by MTP guidelines from 3 prominent societies, the American Society of Anesthesiologists, the American College of Surgeons, and the task force for Advanced Bleeding Care in Trauma...
August 29, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28846895/massive-transfusion-practice-in-non-trauma-related-hemorrhagic-shock
#11
Nauman Farooq, Panagis Galiatsatos, Jasmine K Aulakh, Christopher Higgins, Anthony Martinez
PURPOSE: Evidence suggests that trauma patients with hemorrhagic shock requiring massive transfusion have improved outcomes if resuscitated with a prescribed massive transfusion protocol (MTP). However, there is limited data regarding the efficacy of MTP in non-trauma patients. METHODS: This was a retrospective observational study of all patients who received a massive transfusion protocol for non-traumatic hemorrhagic shock over a four-year period. The primary outcome was in-patient hospital survival...
August 24, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28846577/rotational-thromboelastometry-significantly-optimizes-transfusion-practices-for-damage-control-resuscitation-in-combat-casualties
#12
Nicolas J Prat, Andrew D Meyer, Nichole K Ingalls, Julie Trichereau, Joseph J DuBose, Andrew P Cap
BACKGROUND: Up to 40% of combat casualties with a truncal injury die of massive hemorrhage before reaching a surgeon. This hemorrhage can be prevented with damage control resuscitation (DCR) methods, which are focused on replacing shed whole blood by empirically transfusing blood components in a 1:1:1:1 ratio of platelets:fresh frozen plasma:erythrocytes:cryoprecipitate (PLT:FFP:RBC:CRYO). Measurement of hemostatic function with rotational thromboelastometry (ROTEM) may allow optimization of the type and quantity of blood products transfused...
September 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28837540/multi-institutional-analysis-of-neutrophil-to-lymphocyte-ratio-nlr-in-patients-with-severe-hemorrhage-a-new-mortality-predictor-value
#13
MULTICENTER STUDY
Juan Carlos Duchesne, Danielle Tatum, Glenn Jones, Brandy Davis, Rosemarie Robledo, Marc DeMoya, Terence O'Keeffe, Paula Ferrada, Tomas Jacome, Rebecca Schroll, Jordan Wlodarczyk, Priya Prakash, Brian Smith, Kenji Inaba, Desmond Khor, Marquinn Duke, Mansoor Khan
BACKGROUND: The neutrophil/lymphocyte ratio (NLR) has been associated as a predictor for increased mortality in critically ill patients. We sought to determine the relationship between NLR and outcomes in adult trauma patients with severe hemorrhage requiring the initiation of massive transfusion protocol (MTP). We hypothesized that the NLR would be a prognostic indicator of mortality in this population. METHODS: This was a multi-institutional retrospective cohort study of adult trauma patients (≥18 years) with severe hemorrhage who received MTP between November 2014 and November 2015...
November 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28814247/fluid-and-medication-considerations-in-the-traumatized-patient
#14
Amita Misir
This article reviews fluid therapy and medications in pediatric trauma. For resuscitation in the setting of hemorrhagic shock, isotonic crystalloid solution is the first-line agent of choice. Colloid solutions offer no additional benefit, introduce possible increased risks and cost more than crystalloids. Blood products, starting with pRBCs, should be introduced after 20-40 ml/kg of crystalloid has been administered if there is ongoing need for volume replacement. The use of a massive transfusion protocol of 1:1:1 (if >30 kg) or 30:20:20 (if <30 kg) of pRBCs:FFP:platelets is suggested after an initial 30 ml/kg of pRBcs have been administered...
August 14, 2017: Current Pediatric Reviews
https://www.readbyqxmd.com/read/28771656/transfusion-practice-in-trauma-resuscitation
#15
REVIEW
Ashley M Eckel, John R Hess
Recognition of the acute coagulopathy of trauma and the limits of reconstituting whole blood with conventional blood components has led to a radical change in the way trauma patients with severe injuries are resuscitated. Massive transfusion protocols (MTP) have evolved toward the administration of conventional blood components in fixed ratios. Administration of a 1:1:1 unit ratio of fresh frozen plasma to whole-blood-derived platelets to packed red blood cells is now the most common strategy and the stated goal of directors of >80% of the level I trauma centers in the United States...
August 2017: Southern Medical Journal
https://www.readbyqxmd.com/read/28767599/investigation-of-the-status-quo-of-massive-blood-transfusion-in-china-and-a-synopsis-of-the-proposed-guidelines-for-massive-blood-transfusion
#16
MULTICENTER STUDY
Jiang-Cun Yang, Qiu-Shi Wang, Qian-Li Dang, Yang Sun, Cui-Xiang Xu, Zhan-Kui Jin, Ting Ma, Jing Liu
The aim of this study was to provide an overview of massive transfusion in Chinese hospitals, identify the important indications for massive transfusion and corrective therapies based on clinical evidence and supporting experimental studies, and propose guidelines for the management of massive transfusion. This multiregion, multicenter retrospective study involved a Massive Blood Transfusion Coordination Group composed of 50 clinical experts specializing in blood transfusion, cardiac surgery, anesthesiology, obstetrics, general surgery, and medical statistics from 20 tertiary general hospitals across 5 regions in China...
August 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28765353/hemostatic-management-of-trauma-induced-coagulopathy
#17
Janise B Phillips, Phillip L Mohorn, Rebecca E Bookstaver, Tanya O Ezekiel, Christopher M Watson
Trauma-induced coagulopathy is a primary factor in many trauma-related fatalities. Management hinges upon rapid diagnosis of coagulation abnormalities and immediate administration of appropriate hemostatic agents. Use of crystalloids and packed red blood cells has traditionally been the core of trauma resuscitation, but current massive transfusion protocols include combination therapy with fresh frozen plasma and predefined ratios of platelets to packed red blood cells, limiting crystalloid administration. Hemostatic agents such as tranexamic acid, prothrombin complex concentrate, fibrinogen concentrate, and, in cases of refractory bleeding, recombinant activated factor VIIa may also be warranted...
August 2017: Critical Care Nurse
https://www.readbyqxmd.com/read/28737073/bleeding-pelvic-fracture-patients-evolution-of-resuscitation-protocols
#18
T Söderlund, T Ketonen, L Handolin
BACKGROUND AND AIMS: Massive transfusion protocol seems to improve outcome in massively bleeding trauma patients, but not pelvic fracture patients. The aim of this study was to evaluate the effect of massive transfusion protocol on the mortality and fluid resuscitation of shocked pelvic fracture patients. MATERIAL AND METHODS: This is a trauma register study from a single hospital. From the trauma registry patients with pelvic fracture, injury severity score >15, admission base excess below -5, age >15 years, blunt trauma, and primary admission from the scene were identified...
March 1, 2017: Scandinavian Journal of Surgery: SJS
https://www.readbyqxmd.com/read/28721325/massive-intraoperative-blood-loss-secondary-to-pulmonary-artery-injury-during-a-video-assisted-thorascopic-surgery-the-importance-of-protocols-and-preparedness
#19
Brian Keyes, Erin Giles
Hemorrhagic shock is a potentially devastating surgical condition that can present unexpectedly. This original case report involves a 57-year-old man who experienced unexpected significant blood loss as a result of iatrogenic injury to the pulmonary artery during a video-assisted thorascopic surgery. This case highlights the importance of preparedness and massive transfusion protocols in responding to intraoperative crises of this nature.
June 15, 2017: Curēus
https://www.readbyqxmd.com/read/28719428/blood-product-utilization-among-trauma-and-nontrauma-massive-transfusion-protocols-at-an-urban-academic-medical-center
#20
Eshan U Patel, Paul M Ness, Christi E Marshall, Thomas Gniadek, David T Efron, Peter M Miller, Joseph A Zeitouni, Karen E King, Evan M Bloch, Aaron A R Tobian
BACKGROUND: Hospital-wide massive transfusion protocols (MTPs) primarily designed for trauma patients may lead to excess blood products being prepared for nontrauma patients. This study characterized blood product utilization among distinct trauma and nontrauma MTPs at a large, urban academic medical center. METHODS: A retrospective study of blood product utilization was conducted in patients who required an MTP activation between January 2011 and December 2015 at an urban academic medical center...
September 2017: Anesthesia and Analgesia
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