MASSIVE TRANSFUSION PROTOCOL HOW TO
1, 2 The objective of this article is to provide guidance on how to optimize massive transfusion protocols (MTPs) in the trauma and non-trauma settings. While the military massive transfusion (MT) practices have been refined to improve outcomes over time, the difference in the types of traumatic or non-traumatic injuries, patient health conditions, availability of blood products, and provider-related factors must be considered before applying the same MT practices to a civilian setting. This historical military practice has evolved into a bleeding management strategy for hemorrhagic shock known as damage control resuscitation in the civilian setting. During combat, trauma-associated hemorrhage due to penetrating or blunt injury is often supported by transfusion of whole blood (WB) collected directly from other soldiers. The importance of prompt blood replacement in the setting of uncontrolled hemorrhage is well established and intuitively practiced to resuscitate exsanguinating patients. Introduction and definition of massive transfusion Keywords: hemorrhage, MTP, antifibrinolytics, coagulopathy, trauma, ratio, logistics, guidelines, hemostatic Lastly, we will discuss the best design for an MTP, including ratio-based MTPs and MTPs based on the use of point-of-care coagulation diagnostic tools. Then, we will examine a wide selection of therapeutic products to support MTPs, including newly available products and the most suitable of the traditional products. This article will first discuss specific MTPs targeting different patient populations and current relevant international guidelines. As we come to further understand the positive and negative clinical impacts of transfusion-related factors, massive transfusion practice can be further refined. Much of the MTP literature comes from the trauma population, due to the fact that massive hemorrhage is the leading cause of preventable trauma-related death.
The establishment and utilization of an optimal MTP is challenging given the ever-changing patient status during resuscitation efforts.
There are many variables to consider when establishing an MTP, and studies have prospectively evaluated different scenarios and patient populations to establish the best practices to attain improved patient outcomes. Early optimal blood transfusion is essential to sustain organ perfusion and oxygenation. Yen-Michael S Hsu, 1 Thorsten Haas, 2 Melissa M Cushing 1ġDepartment of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY, USA 2Department of Anesthesia, University Children's Hospital Zurich, Zurich, SwitzerlandĪbstract: Massive transfusion protocols (MTPs) are established to provide rapid blood replacement in a setting of severe hemorrhage.