Massive Blood Transfusion Research Articles

Risk factors of massive blood transfusion (MTP) in cesarean hysterectomy for placenta accreta spectrum

BackgroundPlacenta Accreta Spectrum (PAS) represents a particularly morbid condition for which blood transfusion is the leading cause. Delivery by cesarean hysterectomy is recommended for the management of PAS. Massive Transfusion Protocols (MTP) in obstetrics vary in definition and implementation. Given the significant blood loss during PAS cesarean hysterectomy, this is particularly important for surgeons and blood banks. Our objective was to identify risk factors for MTP in patients with antenatally suspected PAS. MethodsWe performed a case-control study over a 11-year period from 2012 to 2022 at our center for Placenta Accreta Spectrum. MTP was defined by two methods, >4 units or > 10 units of red blood cells/whole blood transfused over 24 h. Antenatal, operative and post-operative outcomes were obtained from electronic medical records of these cases. ResultsDuring the study time frame, 142 cases were managed by our PAS team and met all criteria. 85 % (120/142) of patients were transfused at least 1 unit of blood, 64 patients (45 %) received 0–3 units of blood, 50 patients (35 %) received 4–9 units of blood and 28 patients (19.7 %) were transfused > 10 units of blood. Pre-delivery vaginal bleeding, preterm labor and delivery < 34 weeks were independently significant in transfused patients. ROC analysis revealed an area under the curve (AUC) of 0.79 (p < 0.0001) in patients transfused > 10 units, showing predictive capability for this subgroup. DiscussionWe here report pre-operative risk factors for MTP in patients undergoing cesarean hysterectomy for PAS. This allows for both resource utilization and patient counseling for this morbid maternal condition.

Pre-delivery fibrinogen level is a predictor for severity of placental abruption

ObjectiveTo determine pre-delivery fibrinogen levels in predicting adverse maternal or neonatal outcomes in patients with placental abruption. Materials and methodWe conducted a retrospective study of all women admitted for placental abruption between January 2012 and May 2018. Postpartum hemorrhage (PPH), disseminated intravascular coagulation (DIC), massive blood transfusion and hospitalization in intensive care unit parameters were evaluated for maternal outcomes. For the neonatal outcomes, the 5th minute APGAR score, umbilical artery pH and stillbirth were evaluated. ResultsThe mean predelivery fibrinogen levels were 221.3 ± 111.6 mg/dL. In multivariate logistic regression analysis, fibrinogen level was determined as an independent indicator for PPH, red cell concentrate (RCC) and fresh frozen plasma (FFP) transfusion. When fibrinogen levels decreased below 130 mg/dL, the risk of PPH increased and when fibrinogen levels decreased below 100 mg/dL, the risk of overt DİC and also the risk of red cell concentrate and fresh frozen plasma transfusion increased. In terms of the fetal results, there may be adverse neonatal outcomes when fibrinogen levels are below 250 mg/dL. ConclusionPredelivery fibrinogen levels are good indicators for predicting adverse maternal outcomes in placental abruption cases. In addition, fibrinogen levels might be a guide for management of placental abruption cases.

HPB P20 Radical Single Stage Liver Resection of Bilobar Colorectal Liver Metastases

Abstract Background Surgical resection of Colorectal Liver Metastases (CRLM) offers the best long-term patient survival with current 5-year survival rates of 50%. However, bilobar CRLM often require an individualised patient approach with the primary goals being oncological resection of metastases and adequate future liver remnant. A number of surgical approaches can be used for bilobar CRLM including resection ± ablation, two stage hepatectomy ± portal vein embolization, associating liver partition and portal vein ligation for staged hepatectomy (ALPSS), or extended hepatectomy. We describe our approach of single stage parenchymal preserving (SSPP) liver resection for bilobar CRLM. Methods All patients with bilobar CRLM that underwent liver resection in a single, tertiary, specialist cancer centre in the UK between April 2018 to December 2021 were included. All liver resections were carried out using an open approach and 6-8 weeks after the cessation of chemotherapy. Pringle was used in all patients. We assessed peri-operative and oncological outcomes as well as disease-free (DFS) and overall (OS) patient survival. Results A total of n=42 patients underwent SSPP surgery during the study period. Median age was 54 years (range 36-71) and 93% were performance status=0. Pre-operative chemotherapy was administered in n=39 patients. A median of 4 lesions were resected (range 3-12). Median blood loss was 450mls (range 115-2500mls). R0 resection rate was 95%, with no post-operative liver failure and no peri-operative mortality. Bile leak rate was 10% and n=1 required massive blood transfusion. Median DFS was 13 months, and n=26 patients recurred by the end of the study period. Of these, n=14 were suitable for further treatment. Five-year OS was 77%. Conclusions SSPP liver resection for bilobar CRLM is associated with low peri-operative complications and good oncological outcomes. Early recurrence is noted but patients remain eligible for further liver- directed therapies or systemic treatment allowing for good overall patient survival.

Predictors of intraoperative massive transfusion in orthotopic liver transplantation.

Although transfusion management has improved during the last decade, orthotopic liver transplantation (OLT) has been associated with considerable blood transfusion requirements which poses some challenges in securing blood bank inventories. Defining the predictors of massive blood transfusion before surgery will allow the blood bank to better manage patients' needs without delays. We evaluated the predictors of intraoperative massive transfusion in OLT. Data were collected on patients who underwent OLT between 2007 and 2017. Repeat OLTs were excluded. Analyzed variables included recipients' demographic and pretransplant laboratory variables, donors' data, and intraoperative variables. Massive transfusion was defined as intraoperative transfusion of ≥10 units of packed red blood cells (RBCs). Statistical analysis was performed using SPSS version 17.0. The study included 970 OLT patients. The median age of patients was 57 (range: 16-74) years; 609 (62.7%) were male. RBCs, thawed plasma, and platelets were transfused intraoperatively to 782 (80.6%) patients, 831 (85.7%) patients, and 422 (43.5%) patients, respectively. Massive transfusion was documented in 119 (12.3%) patients. In multivariate analysis, previous right abdominal surgery, the recipient's hemoglobin, Model for End Stage Liver Disease (MELD) score, cold ischemia time, warm ischemia time, and operation time were predictive of massive transfusion. There was a direct significant correlation between the number of RBC units transfused and plasma (Pearson correlation coefficient r = .794) and platelets (r = .65). Previous abdominal surgery, the recipient's hemoglobin, MELD score, cold ischemia time, warm ischemia time, and operation time were predictive of intraoperative massive transfusion in OLT.

Evaluation of gynecology and gynecologic oncology cases who received massive blood transfusion: a tertiary center experience

Aims: To examine the frequency, indications and results of massive blood transfusion in gynecology and gynecological oncology cases.&#x0D; Methods: The data of 56 cases who were underwent massive blood transfusion and operated on for benign/ malignant pathology indications in the gynecology and gynecological oncology clinics between October 1, 2022 and August 1, 2023, within a period of 10 months, were retrospectively analyzed. Demographic data of the cases (age, gravida, parity, body mass index), indications for hospitalization, vital signs during hospitalization, hemoglobin (Hb), hematocrit (Htc), platelet and INR values, massive transfusion indications, transfused blood products (erythrocyte suspansion, fresh frozen plasma (FFP), pooled platelet suspension, cryoprecipitate, fibrinogen) and the length of stay in the intensive care unit and hospitalization were retrospectively screened and analyzed statistically. The statistical significance level was accepted as p0.05). However, when the decision for transfusion was made, the INR value was statistically significantly higher in gynecological oncology cases (p=0.001). While the amounts of erythrocyte suspension given were similar between the two patient groups (5.1±1.4 vs. 6.3±3.5 U, p= 0.082), FFP amounts were higher in the gynecologic oncology group (3.3±2.0 vs. 6.2±3.7 U, p=0.001). When the blood groups of the cases were examined, it was seen that the most common blood groups were O (+) (n= 18, 32.1%) and A (+) (n=16, 28.6%). The duration of stay in the intensive care unit and hospitalization of gynecological oncology cases was significantly longer in gynecological cases. While 1 of 56 patients who underwent massive blood transfusion died (gynecological oncology case), 55 patients were discharged.&#x0D; Conclusion: Timely transfusion decision is safe and life-saving in massive hemorrhages.

Incidence of Obstetric Massive Blood Transfusion and Clinicial Features: Hospital-Based Study

Aim: To determine the incidence of obstetric massive blood transfusion in a tertiary center, to determine the characteristics of massive blood transfusion, its main causes and adverse outcomes in obstetric cases, thus trying to contribute to the creation of obstetric emergency plans.&#x0D; Materials and methods: The results of 39 cases who underwent massive blood transfusion for obstetric indications were reviewed retrospectively. Demographic data of the cases (age, gravida, parity, body mass index), indications for hospitalization, vital signs during hospitalization, shock index, hemogram values and INR values, massive transfusion indications, transfused blood products (and in intensive care/intensive care units) from patient medical files. Length of hospital stay, reactions and complications related to massive transfusion were recorded.The cases who underwent obstetric massive blood transfusion were divided into 2 groups as low-risk pregnancy and high-risk pregnancy.The data were also compared between the 2 groups.&#x0D; Results: The rate of massive blood transfusion was found to be 26 (12/4607) in 10000 pregnancies in low-risk pregnancies and 1.2% (27/2269) in high-risk pregnancies. Transfusion was started in 21 of 33 cases who underwent cesarean section due to massive bleeding that occurred intraoperatively. The time between the decision of transfusion due to obstetric hemorrhage and initiation of transfusion, and the vital signs and shock indices of the cases at the time of initiation of transfusion were similar between the groups (p&gt;0.05). However, while the Hb and Htc levels were statistically lower in the low-risk group at the time of initiation of transfusion, the INR value was statistically higher in the high-risk group.&#x0D; Conclusion: In massive obstetric hemorrhages, which is one of the most important causes of maternal mortality, application of surgical procedures (compression sutures, arter ligation or hysterectomy) combined with massive blood transfusion is life-saving.

Massive immediate post-tracheostomy bleeding from the innominate artery

IntroductionTracheostomy is a surgical airway management procedure that involves making an incision on the anterior neck and opening a direct airway through an incision in the trachea.AimWe report a case of a difficult tracheostomy complicated by massive immediate bleeding from the innominate artery that required a median sternotomy for vascular access and control.Case studyA 26-year-old lady with a short neck underwent a tracheostomy in a semi-emergency setting in view of prolonged intubation and frequent intubation prior. The tracheal incision was performed in between the 3rd and 4th tracheal rings and was complicated by massive bleeding from the innominate artery tear that was located below the sternum and necessitated a midline sternotomy procedure to access the artery. The artery was then repaired primarily and covered with a strap muscle that was swung over to the right and sutured to the periosteum of the right clavicle. She lost 6 L of blood, prompting a massive blood transfusion. Postoperatively, there was no bleeding from the wound, but she had an infected sternotomy wound that was managed with antibiotics and dressings. The tracheostomy tube care was uneventful.Results and discussionThe short-neck hyperextension during trachea exposure can cause major thoracic vessels and tracheal rings to move upward, leading to tracheal incisions being made lower than intended and risking major vessel injury.ConclusionsImaging before surgery is recommended to delineate the anatomy and detect any major vessels present in the case of anticipated difficult tracheostomy.

Risk factors of massive blood transfusion in liver transplantation: consequences and a new index for prediction including the donor

Risk factors of massive blood transfusion in liver transplantation: consequences and a new index for prediction including the donor

Risk factors of massive blood transfusion in liver transplantation: consequences and a new index for prediction including the donor

BackgroundMassive blood transfusion (MBT) is a common occurrence in liver transplant (LT) patients. Recipient-related risk factors include cirrhosis, history of multiple surgeries and suboptimal donors. Despite advances in surgical techniques, anesthetic management and graft preservation have decreased the need for transfusions, this complication has not been completely eliminated. MethodsOne thousand four hundred and sixty-nine LT were performed at our institution between May 2003 and December 2020, and data was available regarding transfusion for 1198 of them. We divided the patients into two groups, with regards to transfusion of 6 or more units of packed red blood cells in the first 24 h posttransplant, and we analyzed the differences between the groups. ResultsOut of the 1198 patients, 607 (50.7%) met criteria for MBT. Survival was statistically lower at 1, 3, and 5 years when comparing the groups that had MBT to those that did not (92.6%, 85.2% and 79.7%, respectively, in the non MBT group, vs. 78.1%, 71.6% y 66.8%, respectively, in the MBT group). MBT was associated with a 1.5 mortality risk as opposed to non-MBT patients. Logistical regression analysis of our variables yielded the following results for a new model, including serum creatinine (OR 1.97), sodium (OR 1.73), hemoglobin (OR 1.99), platelets (OR 1.37), INR (OR 1.4), uDCD (OR 2.13) and split liver donation. ConclusionMassive blood transfusion impacts patient survival in a statistically significant way. The most significant risk factors are preoperative hemoglobin, INR and serum creatinine.

PLACENTA ACCRETA SPECTRUM DISORDERS

Placenta accreta spectrum is a rare pathology, but there is an increase in the incidence of placenta accreta. In the accreta spectrum, abnormal placental adherence to the myometrium stems in part from partial or total absence of the decidua basalis and imperfect development of the fibrinoid or Nitabuch layer. This results in the absence of a physiological line of cleavage, so resulting in failure of separation of the placenta causing significant hemorrhage. This leads to maternal morbidity and mortality. 12 patients of placenta accreta managed at Government Medical College and Rajindra Hospital, Patiala, over 1 year (December 2021–November 2022) were reported. All cases had a histopathologically proven diagnosis of placenta accreta. The major risk factors identified were placenta previa, previous cesarean section, multiparity, advanced maternal age, previous uterine surgeries, or curettage. Ultrasound (USG) color Doppler and magnetic resonance imaging allowed us to strongly suspect the presence of placenta accreta in a pregnant woman with risk factors. Placenta accreta spectrum is associated with life-threatening hemorrhage, urinary bladder injury, intensive care unit admission, massive blood transfusion, and maternal death. The course of action in each and every patient varies according to whether the diagnosis of the placenta is made antenatal or during C-section and the amount of blood loss.

Early plasma proteomic biomarkers and prediction model of acute respiratory distress syndrome after cardiopulmonary bypass: a prospective nested cohort study.

Early recognition of the risk of acute respiratory distress syndrome (ARDS) after cardiopulmonary bypass (CPB) may improve clinical outcomes. The main objective of this study was to identify proteomic biomarkers and develop an early prediction model for CPB-ARDS. We conducted three prospective nested cohort studies of all consecutive patients undergoing cardiac surgery with CPB at XXX Hospital. Plasma proteomic profiling was performed in ARDS patients and matched controls (Cohort 1, April, 2021 to July, 2021) at multiple timepoints: before CPB (T1), at end of CPB (T2), and 24 h after CPB (T3). Then, for Cohort 2 (August, 2021 to July, 2022), biomarker expression was measured and verified in the plasma. Furthermore, lung ischemia/reperfusion injury (LIRI) models and sham-operation were established in 50 rats to explore the tissue-level expression of biomarkers identified in the aforementioned clinical cohort. Subsequently, a machine learning-based prediction model incorporating protein and clinical predictors from Cohort 2 for CPB-ARDS was developed and internally validated. Model performance was externally validated on Cohort 3 (January, 2023 to March, 2023). A total of 709 proteins were identified, with 9, 29, and 35 altered proteins between ARDS cases and controls at T1, T2, and T3, respectively, in Cohort 1. Following quantitative verification of several predictive proteins in Cohort 2, higher levels of thioredoxin domain containing 5 (TXNDC5), cathepsin L (CTSL), and NPC intracellular cholesterol transporter 2 (NPC2) at T2 were observed in CPB-ARDS patients. A dynamic online predictive nomogram was developed based on three proteins (TXNDC5, CTSL, and NPC2) and two clinical risk factors (CPB time, massive blood transfusion), with excellent performance (precision: 83.33%, sensitivity: 93.33%, specificity: 61.16%, F1 score: 85.05%). Mean area under the receiver operating characteristics curve (AUC) of the model after 10-fold cross-validation was 0.839 (95% confidence interval (CI): 0.824 to 0.855). Model discrimination and calibration were maintained during external validation dataset testing, with AUC of 0.820 (95% CI: 0.685 to 0.955) and Brier Score of 0.177 (95% CI: 0.147 to 0.206). Moreover, the considerably overexpressed TXNDC5 and CTSL proteins identified in the plasma of patients with CPB-ARDS, exhibited a significant upregulation in the lung tissue of LIRI rats. This study identified several novel predictive biomarkers, developed and validated a practical prediction tool using biomarker and clinical factor combinations for individual prediction of CPB-ARDS risk. Assessing the plasma TXNDC5, CTSL, and NPC2 levels might identify patients who warrant closer follow-up and intensified therapy for ARDS prevention following major surgery.

Predictive Factors and Bio-Clinical Scoring Systems of Massive Blood Transfusion in Trauma Patients Attending Emergency Department

Predictive Factors and Bio-Clinical Scoring Systems of Massive Blood Transfusion in Trauma Patients Attending Emergency Department

Development of Prehospital Factors for Predicting Massive Blood Transfusion in Trauma Patients

Background: Massive blood loss is the primary cause of immediate death in trauma patients. In prehospital care, where laboratory and investigation resources are limited, a massive blood transfusion (MBT) scoring system could activate blood bank preparation of blood components and facilitate EMS decision-making regarding the appropriate trauma center destination. This is particularly significant in urban environments where motor vehicle accidents are highly prevalent. Materials and Methods: A retrospective cohort study was conducted using data from prehospital trauma patients. Predictive parameters, including vital signs, mechanism of injury, and serious injury body parts, were analyzed, and the significant parameters identified by a multivariable analysis were used to develop a clinical scoring system. Discrimination was evaluated by the area under the receiver operating characteristic (AuROC) curve, calibration was demonstrated with the Hosmer-Lemeshow goodness of fit test, and internal validation was performed. Results: Among 511 trauma patients, 72 (14.1%) received MBT. The prehospital factors that significantly predicted massive MBT included hypotension with a SBP of less than 90 mmHg, penetrating object injuries, serious injuries to the face, thorax, abdomen, extremities including the pelvis, and the use of life-saving interventions such as advanced airway management and pelvic binding. The AuROC was 0.943 (95% CI 0.914 to 0.972, p&lt;0.001). The probability of receiving massive transfusion was 94.79% in patients with score of 5 or higher. Conclusion: The prehospital MBT score demonstrates good performance and discrimination for predicting MBT using simple and rapidly obtainable parameters in a prehospital setting. Keywords: Massive transfusion; Massive bleeding; Prehospital care

Massive Transfusion Increases Serum Magnesium Concentration.

(1) Background: The massive transfusion of packed red blood cells (RBCs) is a lifesaving procedure, but it is associated with complications, e.g., dysmagnesemia. Since magnesium is an intracellular ion, the transfused RBCs can significantly influence the magnesium concentration in the recipient's blood. (2) Methods: A retrospective study was performed among 49 patients hospitalized in the Central Clinical Hospital of the Medical University of Warsaw who received a massive blood transfusion (≥4 units/h). Data on laboratory results and patient history were collected from the hospital database. The intracellular RBCs magnesium concentration was measured in 231 samples using the colorimetric method. (3) Results: There were statistically significant changes in the mean serum magnesium concentration preoperatively and 24 h postoperatively (0.87 ± 0.13 vs. 1.03 ± 0.14, p < 0.00001) and 48 h postoperatively (0.87 ± 0.13 vs. 1.06 ± 0.15, p < 0.00001). Patients who died had significantly higher serum magnesium concentrations (p < 0.05). The median intracellular magnesium concentration in RBCs was 0.91 (0.55-1.8) mmol/L, which is below the reference values of 1.65-2.65 mmol/L. (4) Conclusions: Transfused RBCs significantly increased the serum magnesium concentration 24 h and 48 h postoperatively. It could be a result of mild hemolysis, as the median intracellular magnesium concentration in RBCs was below the reference values.

CLRM-03 THE TENTATIVE APPLICATION OF EN BLOC CONCEPT IN THE PEDIATRIC BRAIN TUMOR: EXPERIENCE FROM A LARGE PEDIATRIC CENTER IN CHINA

Abstract BACKGROUND The less allowable blood loss and tolerance of intraoperative blood loss of children lead to the high rate of massive blood transfusion. The surgical concepts of en bloc resection may contribute to the improvement of brain tumor resection. OBJECTIVE To investigate the effects of en bloc concept on short outcomes of pediatric brain tumors and factors associated with the application of en bloc concept. METHODS According to the surgical concept involved, the patients were divided into three subgroups-complete en bloc concept, partial en bloc concept and piecemeal concept. The matching-comparison(en bloc group consisting of the first two subgroups and piecemeal group) was conducted to investigate the effect of the en bloc concept on the short-term outcomes. Then the patient data after January 2018, when the en bloc concept was routinely integrated into brain tumor surgery in our medical center, were reviewed and analyzed to find out the predictors associated with the application of en bloc concept. RESULTS In the en bloc group, the perioperative outcomes, including hospital stay(p=0.001), PICU stay(p=0.003), total blood loss(p=0.015), transfusion rate(p=0.005) and complication rate(p=0.039), were all significantly improved. The multinomial logistic regression analysis showed that tumor volume, bottom vessel, and imaging features, like encasing nerve or pass-by vessel, finger-like attachment, ratio of “limited line” and ratio of “clear line” remained independent predictors for the application of en bloc concept in our medical center. CONCLUSION The application of en bloc concept based on the imaging features can improve the short-term outcomes.

Using Liver Function Indicators to Predict Massive Blood Transfusion in Orthotopic Liver Transplantation

To explore the predictive effect of preoperative liver function indicators for intraoperative massive blood transfusion in orthotopic liver transplantation and to establish a prediction model. We retrospectively analyzed the relevant data of 607 patients who underwent orthotopic liver transplantation in the Department of Liver Surgery, West China Hospital, Sichuan University between January 1, 2015 and June 30, 2021. According to the intraoperative transfusion volume of leukocyte-reduced red blood cells in additive solution, the patients were divided into a massive blood transfusion (MBT) group and a non-massive blood transfusion (NMBT) group. Univariate and multivariate logistic regressions were performed to analyze the risk factors of intraoperative MBT in orthotopic liver transplantation, the calibration of the predictive model was assessed by Hosmer-Lemeshow test, and the discrimination power of the predictive model was measured by area under the curve ( AUC) of the receiver operating characteristic (ROC) curve. According to the results of logistic regression, alanine transaminase (ALT), aspartate transaminase (AST), total bilirubin (TBIL), direct bilirubin (DBIL), albumin (ALB), and Child-Pugh score showed no correlation with the risk of MBT in orthotopic liver transplantation operation. Platelet count (PLT) (odds ratio [ OR]=0.90, 95% confidence interval [ CI]: 0.09-0.19, P=0.02), international normalized ratio (INR) ( OR=19.43, 95% CI: 7.64-19.44, P<0.01), prothrombin time (PT) ( OR=1.43, 95% CI: 1.25-1.63, P<0.01), and activated partial thromboplastin time (APTT) ( OR=0.92, 95% CI: 0.90-0.95, P<0.01) were identified as the risk factors of intraoperative MBT in orthotopic liver transplantation. The Hosmer-Lemeshow test showed that the predictive model had good calibration ( χ 2=9.06, P=0.48) and discrimination power ( AUC=0.80, 95% CI 0.766-0.834, P<0.01). A predictive model based on the preoperative PLT, INR, PT, and APTT of patients undergoing orthotopic liver transplantation was established and can be used to predict the risk of intraoperative MBT in liver transplantation patients.

Assessment of Machine Learning Methods to Predict Massive Blood Transfusion in Trauma

BackgroundAccurately predicting which patients are most likely to benefit from massive transfusion protocol (MTP) activation may help patients while saving blood products and limiting cost. The purpose of this study is to explore the use of modern machine learning (ML) methods to develop and validate a model that can accurately predict the need for massive blood transfusion (MBT).MethodsThe institutional trauma registry was used to identify all trauma team activation cases between June 2015 and August 2019. We used an ML framework to explore multiple ML methods including logistic regression with forward and backward selection, logistic regression with lasso and ridge regularization, support vector machines (SVM), decision tree, random forest, naive Bayes, XGBoost, AdaBoost, and neural networks. Each model was then assessed using sensitivity, specificity, positive predictive value, and negative predictive value. Model performance was compared to that of existing scores including the Assessment of Blood Consumption (ABC) and the Revised Assessment of Bleeding and Transfusion (RABT).ResultsA total of 2438 patients were included in the study, with 4.9% receiving MBT. All models besides decision tree and SVM attained an area under the curve (AUC) of above 0.75 (range: 0.75–0.83). Most of the ML models have higher sensitivity (0.55–0.83) than the ABC and RABT score (0.36 and 0.55, respectively) while maintaining comparable specificity (0.75–0.81; ABC 0.80 and RABT 0.83).ConclusionsOur ML models performed better than existing scores. Implementing an ML model in mobile computing devices or electronic health record has the potential to improve the usability.

Data-Driven Blood Transfusion Thresholds for Severely Injured Patients During Blood Shortages

IntroductionCrises like the COVID-19 pandemic create blood product shortages. Patients requiring transfusions are placed at risk and institutions may need to judiciously administer blood during massive blood transfusions protocols (MTP). The purpose of this study is to provide data-driven guidance for the modification of MTP when the blood supply is severely limited. MethodsThis is a retrospective cohort study of 47 Level I and II trauma centers (TC) within a single healthcare system whose patients received MTP from 2017 to 2019. All TC used a unifying MTP protocol for balanced blood product transfusions. The primary outcome was mortality as a function of volume of blood transfused and age. Hemoglobin thresholds and measures of futility were also estimated. Risk-adjusted analyses were performed using multivariable and hierarchical regression to account for confounders and hospital variation. ResultsProposed MTP maximum volume thresholds for three age groupings are as follows: 60 units for ages 16-30 y, 48 units for ages 31-55 y, and 24 units for >55 y. The range of mortality under the transfusion threshold was 30%-36% but doubled to 67-77% when the threshold was exceeded. Hemoglobin concentration differences relative to survival were clinically nonsignificant. Prehospital measures of futility were prehospital cardiac arrest and nonreactive pupils. In hospital risk factors of futility were mid-line shift on brain CT and cardiopulmonary arrest. ConclusionsEstablishing MTP threshold practices under blood shortage conditions, such as the COVID pandemic, could sustain blood availability by following relative thresholds for MTP use according to age groups and key risk factors.

Major Trauma and the use of Tranexamic Acid in Children

Objective was to determine reduction in blood loss in children with major trauma with or without using Tranexamic acid Methods: A study included 260 patients admitted to pediatric surgery departments at Mayo Hospital, Children's Hospital, and Jinnah Hospital in Lahore, from September, 2018 to April, 2019. Patients were divided into Tranexamic acid and control groups. Both groups received standard treatment and blood transfusion requirements. Patients were followed for length of stay and final outcomes. Results: Mean injury severity score in case and control groups was 26.61±11.17 and 29.00±11.64 respectively. Mean hospital stay was significantly shorter (p = 0.002], massive blood transfusions were significantly low [3.8% vs. 38.46%, p-value&lt;0.001] and need of surgery [24.6% vs. 46.15%, p &lt;0.001]. Mortality rate 1.54% vs. 7.69%, p =0.018 and discharge rate 98.64% vs. 92.31%,p = 0.018). Blood transfusion requirement and need of surgery were significant predictors for mortality in this study. Conclusion: Results of this study demonstrate that Tranexamic Acid can be effectively used to minimize blood transfusion requirement in children with major trauma. It effectively reduces the need of massive blood transfusion, minimizing mortality and shortens the hospital stay for pediatric patients. Keywords: Tranexamic acid, Effectiveness, Blood loss, Children, Trauma

Accuracy of Point-of-Care Blood Glucometers in Neonates and Critically Ill Adults

Inpatient glycemic management has become a common issue because of the increasing number of hospitalized patients with hyperglycemia. Point-of-care devices can enable timely inpatient glucose monitoring, which may lead to better outcomes. The accuracy of point-of-care testing in various clinical scenarios has been questioned, particularly in neonates and critically ill patients. This study aimed to evaluate the accuracy of the CONTOUR PLUS and CONTOUR PLUS ONE glucometers (new wireless systems that link to a smart mobile device) when used as point-of-care devices for blood glucose monitoring in neonates and critically ill adults in inpatient settings. This cross-sectional study was conducted at a medical center in central Taiwan and enrolled patients admitted to the neonatal intensive care unit, sick child room, or respiratory intensive care unit between November 2020 and April 2021. Neonates with suspected infection or abnormal blood coagulation and adults who had abnormal blood coagulation, were pregnant, had received organ transplants, or had undergone massive blood transfusions were excluded. The accuracy of the glucometers was determined based on the following criteria of the International Organization for Standardization (ISO) standard: 15197:2013. Overall, 114 neonates (mean age, 4.2 days [range, 0-28 days]; 65 boys [57.0%]) and 106 hospitalized critically ill adults (mean age, 68.2 years [range, 27-94 years]; 72 men [67.9%]) were enrolled in this study. The glucose values obtained with each glucometer had good precision, and all findings met the reference criteria of the within-lot results. All measurements of the neonates' venous blood by each glucometer met the accuracy criteria specified by ISO standard 15197:2013. Furthermore, 98.1% and 97.2% of the arterial blood glucose measurements for critically ill adults obtained with CONTOUR PLUS and CONTOUR PLUS ONE met the accuracy criteria, respectively. Both glucose management systems met the accuracy criteria for venous blood from neonates and arterial blood from critically ill adults. Thus, the use of these 2 point-of-care devices in inpatient settings, including for neonates and critically ill adults, can be recommended to minimize limitations associated with the clinical application of point-of-care testing in glucose management. The wireless connection may play a role in the subsequent development of institution-wide virtual glycemic management under the supervision of a team of endocrinologists.