Massive Hemorrhage Protocol
Time is life! Every one-minute delay in receiving the first pRBC is associated with a 5% increase in mortality - Saswata Deb & Priyank Bhatnagar
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The 7 Ts of Massive Hemorrhage Protocols
Our experts recommend a 2:1:1 ratio of blood products based on their interpretation of the PROPPR trial which found that among patients with severe trauma and major bleeding there was no significant difference in 24hr or 30 day mortality in patients who received a 1:1:1 ratio compared to a 2:1:1 ratio, and because of practical considerations that allow faster administration of blood products using the 2:1:1 ratio.
The first case of blood products should contain 4 units uncrossmatched pRBCs, be at the bedside in under 10 minutes, and IV running via rapid transfuser shortly thereafter.
Then the next case of blood products contains 4 RBC and 4 plasma (FFP) which should run…
Resources
Treat the Bleed
The massive hemorrhage protocol (MHP) is a clinical pathway that brings together the right patient, right team, and right interventions at the right time points. MHP has been shown to improve patient outcomes and must incorporate the best available evidence and practices. The components of MHP are best summarized in terms of 7 Ts: trigger, team, tranexamic acid, testing, transfusion, temperature, and termination.
ABC Score for Massive Transfusion
Once adopted or incorporated into a prehospital or ED massive transfusion protocol, one can evaluate for impact on timing of delivery of products and for potential wastage. While it was developed to determine successful prediction of patients who would receive 10 units of RBCs, many major transfusions involve less than 10 units in the current 1:1:1 paradigm where we get hemostasis much sooner. What we have done is look at predicting those who receive one cooler of products (6 RBCs, 6 plasma, "6-pack" platelets), rather than 10 units of RBCs.
Massive Hemorrhage Protocols: The 7 Ts
Outcomes in polytrauma depend not only on prompt recognition of occult shock and early source control of bleeding but on having a standardized massive hemorrhage protocol (MHP) that enables rapid and coordinated delivery of lifesaving blood products and medications.
Massive Transfusion Protocol in Traumatic Hemorrhage
MTP is highly institution-dependent, but the overall principle is that blood should be replaced at a 1:1:1 ratio of RBCs to platelets to fresh frozen plasma (FFP), as various studies have suggested improved outcomes with balanced transfusion compared to different ratios of blood products or pRBCs alone.
Massive transfusion: a review
This review article will discuss the history of MT, provide various definitions for massive hemorrhage and MT, explain the pathophysiology of the acutely bleeding patient, highlight balanced hemostatic resuscitation and its critical elements in various patient populations...
Massive'Obstetric'Hemorrhage The'Team'Approach'
MTP:'New'developments: FFP:PRBC'–'1:2'(evolving). Recombinant'AcGvated'Factor'VII'.
Pediatric Traumatic Hemorrhage: Massive Transfusion for Tiny Patients
However what we don't know right now is what the survival impact is around MTPs in the pediatric patient. It'll be interesting to see what the addition of TXA to MTP protocols does for that overall survival rate.
The 7 Ts of Massive Hemorrhage Protocols
The classic definition of massive transfusion protocol is 10 units of pRBC over 24 hours and only focuses on the number of blood products transfused. Instead, the emphasis should be placed on hemorrhage control which not only includes transfusions, but also monitoring blood work/considering targets, administration of other medications including tranexamic acid, keeping the patient warm and source control of the bleeding.
Life in the Fastlane
Hb: This should not be used alone as transfusion trigger; and, should be interpreted in context with haemodynamic status, organ & tissue perfusion.
Massive transfusion protocol template
This document, Patient Blood Management Guidelines: Module 1 – Critical Bleeding/Massive Transfusion, is the first in a series of six modules that focus on evidence-based patient blood management.
Rush Emergency Medicine
The goal of MTP is to rapidly provide blood products while also preventing the “lethal triad” of acidosis, hypothermia, and coagulopathy that prolongs hemorrhage.
WikEM
The PROPPR trial[5] examined a 1:1:1 (FFP:Plt:pRBC) vs 1:1:2 protocol. There was no difference in mortality at 1 or 30 days; however, the 1:1:1 group experienced less death due to exsanguination in the first day.
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