Massive Transfusion Protocols in Trauma Care

Abstract

Objectives Describe planning and implementation of a massive transfusion protocol (MTP) for a large urban trauma service. Stress the coordination and education effort involving many hospital services prior to introduction of the protocol. Review the available data on clotting function during rapid exsanguination, and the optimal distribution of blood products for fluid resuscitation (packed red blood cells, plasma, platelets, cryoprecipitate, and recombinant Factor VIIa) during ongoing blood loss. Discuss the difficulty of designing research in trauma patients to demonstrate significant benefit to these patients caused by the MTP. Present preliminary outcome data using the MTP (compared with prospectively gathered historical control data collected in the year prior to introduction of the MTP), which shows a decrease in the number of blood products required for fluid resuscitation in surgery, implying some benefit in trauma patients by providing control of coagulopathy. INTRODUCTION The design and implementation of a massive transfusion protocol (MTP) for use in trauma care in a large urban hospital is described. The MTP provides rapidly bleeding patients with automatic regular shipments of blood products to facilitate fluid resuscitation during emergency care and surgery. Design of the protocol, particularly the choice of ratio between packed red blood cells, plasma, and platelets at each stage of resuscitation, is discussed based on results of recent studies concerning the need for volume support, oxygen delivery, and coagulation support during ongoing blood loss and surgery.