Resuscitation Unit Research Articles

THE ANALYSIS OF HOSPITALIZATION IN MASSIVE ADMISSIONS OF VICTIMS TO N.V. SKLIFOSOVSKY RESEARCH INSTITUTE FOR EMERGENCY MEDICINE

N.V. Sklifosovsky Research Institute for Emergency Medicine is the main clinical base for medical elimination of mass disasters consequences, and about 20% of victims arrive here in emergency situations in Moscow. The current clinical structure of N.V. Sklifosovsky Research Institute for Emergency Medicine provides for the provision of skilled medical care to a large number of patients in massive admissions. Resuscitation departments of various specialties are organized at the Institute. In elimination of medical consequences of mass disasters, 11 clinical departments with 544 beds and 9 resuscitation departments are used. The capacity of resuscitation units (101 beds) allows to admit a large number of severely affected patients simultaneousely, including patients with combined and multisystem trauma, as well as to re-admit after surgery, taking into account the type of injury.

ВЛИЯНИЕ ТЯЖЁЛОЙ ЗАКРЫТОЙ ТРАВМЫ ГРУДНОЙ КЛЕТКИ НА ГАЗООБМЕН

Objective: Study of the mechanisms of gas exchange abnormalities in a chest injury. Methods: The state of gas exchange was studied in 40 patients with the blunt chest trauma (BCT) in the resuscitation unit of the National Medical Center of Tajikistan. In 10 (25%) patients were isolated, in 30 (75%) – combined injuries. Results: The function of external respiration with the BCT was characterized with the reduction of respiratory volume and vital capacity of lungs, which was conducted with evident pain factor leading to the limitation of respiratory chest excursion. Conclusion: The leading reasons for acute respiratory failures lay to severe arterial hypoxemia on the BCT are intrapulmonary trauma changes (lung contusion, multiple fractures of the rib), which cause to sharp enlargement of intrapulmonary shunting. In case of the chest injury without intrapulmonary damages, the main treatment measures should be aimed at eliminating the pain syndrome as the main pathogenetic mechanism of gas exchange disturbances. In the presence of intrapulmonary traumatic changes, the thorough sanitation of the tracheobronchial tree, the prevention of pneumonia and the transfer to artificial lung ventilation are of primary importance. Keywords: Blunt chest trauma, closed chest injury, gas exchange, disturbance of external respiration functions, artificial lung ventilation.

The Direct Cost of Treatment of Traumatic Brain Injury in a Sub-Saharan African Country (Benin).

This is the first socioeconomic study on traumatic brain injury (TBI) undertaken to determine the sociodemographic factors implicated in the occurrence of TBI and to assess the value of the direct cost of the management of TBI at the initial phase in the Hubert Koutoukou Maga National Teaching Hospital of Cotonou. This was a prospective study with descriptive and analytic aim that took place from January 1 to July 31, 2014. An individual approach of each patient's expenditure was undertaken via the use of a questionnaire on which all expenses were identified systematically. The dependent variable was the global direct cost of care. The independent variables were the type of accident, severity of the TBI, the structures of care, the stay in the resuscitation unit, the duration of hospitalization. There were 297 patients with TBI: 258 men (86.9%) and 39 women (13.1%), with a sex ratio of 6.61. The average age of patients was 34.3 ± 12.39 years. The average direct cost of care for TBI was €285.67 ± 310.15. The average cost for severe TBI was €522.08 ± 439.91 versus €188.19 ± 164.83 for mild TBI (odds ratio 5.52; standard deviation: 0.0527-0.6222). The average cost was increased significantly more when the patients went through a peripheral hospital (odds ratio 3.65; standard deviation: 1.819-7.3245). The organization of Benin's health system did not allow for the optimum management of TBI. It seems imperative to develop an insurance system that will allow a proper and effective support for victims of traffic accidents.

Reliable Collection of Real-Time Patient Physiologic Data from less Reliable Networks: a "Monitor of Monitors" System (MoMs).

Research and practice based on automated electronic patient monitoring and data collection systems is significantly limited by system down time. We asked whether a triple-redundant Monitor of Monitors System (MoMs) to collect and summarize key information from system-wide data sources could achieve high fault tolerance, early diagnosis of system failure, and improve data collection rates. In our Level I trauma center, patient vital signs(VS) monitors were networked to collect real time patient physiologic data streams from 94 bed units in our various resuscitation, operating, and critical care units. To minimize the impact of server collection failure, three BedMaster® VS servers were used in parallel to collect data from all bed units. To locate and diagnose system failures, we summarized critical information from high throughput datastreams in real-time in a dashboard viewer and compared the before and post MoMs phases to evaluate data collection performance as availability time, active collection rates, and gap duration, occurrence, and categories. Single-server collection rates in the 3-month period before MoMs deployment ranged from 27.8% to 40.5% with combined 79.1% collection rate. Reasons for gaps included collection server failure, software instability, individual bed setting inconsistency, and monitor servicing. In the 6-month post MoMs deployment period, average collection rates were 99.9%. A triple redundant patient data collection system with real-time diagnostic information summarization and representation improved the reliability of massive clinical data collection to nearly 100% in a Level I trauma center. Such data collection framework may also increase the automation level of hospital-wise information aggregation for optimal allocation of health care resources.

Efficacy and Safety of Outpatient Treatment Based on the Hestia Clinical Decision Rule with or without N-Terminal Pro-Brain Natriuretic Peptide Testing in Patients with Acute Pulmonary Embolism. A Randomized Clinical Trial.

Outpatient treatment of pulmonary embolism (PE) may lead to improved patient satisfaction and reduced healthcare costs. However, trials to assess its safety and the optimal method for patient selection are scarce. To validate the utility and safety of selecting patients with PE for outpatient treatment by the Hestia criteria and to compare the safety of the Hestia criteria alone with the Hestia criteria combined with N-terminal pro-brain natriuretic peptide (NT-proBNP) testing. We performed a randomized noninferiority trial in 17 Dutch hospitals. We randomized patients with PE without any of the Hestia criteria to direct discharge or additional NT-proBNP testing. We discharged the latter patients as well if NT-proBNP did not exceed 500 ng/L or admitted them if NT-proBNP was greater than 500 ng/L. The primary endpoint was 30-day adverse outcome defined as PE- or bleeding-related mortality, cardiopulmonary resuscitation, or intensive care unit admission. The noninferiority margin for the primary endpoint was 3.4%. We randomized 550 patients. In the NT-proBNP group, 34 of 275 (12%) had elevated NT-proBNP values and were managed as inpatients. No patient (0 of 34) with an elevated NT-proBNP level treated in hospital (0%; 95% confidence interval [CI], 0-10.2%), versus no patient (0 of 23) with a post hoc-determined elevated NT-proBNP level from the direct discharge group (0%; 95% CI, 0-14.8%), experienced the primary endpoint. In both trial cohorts, the primary endpoint occurred in none of the 275 patients (0%; 95% CI, 0-1.3%) subjected to NT-proBNP testing, versus in 3 of 275 patients (1.1%; 95% CI, 0.2-3.2%) in the direct discharge group (P = 0.25). During the 3-month follow-up, recurrent venous thromboembolism occurred in two patients (0.73%; 95% CI, 0.1-2.6%) in the NT-proBNP group versus three patients (1.1%; 95% CI, 0.2-3.2%) in the direct discharge group (P = 0.65). Outpatient treatment of patients with PE selected on the basis of the Hestia criteria alone was associated with a low risk of adverse events. Given the low number of patients with elevated NT-proBNP levels, this trial was unable to draw definite conclusions regarding the incremental value of NT-proBNP testing in patients who fulfill the Hestia criteria. Clinical trial registered with www.trialregister.nl/trialreg/admin/rctview.asp?TC=2603 (NTR2603).

Estudio prospectivo aleatorizado sobre el impacto de las medidas fast track en la cirugía abierta de aneurismas de aorta abdominal

IntroductionImplementation of fast track (FT) measures for abdominal aortic aneurysm (AAA) open repair (OR) has not been sufficiently evaluated in our area. ObjectiveThe impact of implementing FT measures in our patients. Material and methodsA prospective, randomised study (control and FT groups) was designed and conducted on patients with an infrarenal AAA >55mm between July 2011 and January 2014 undergoing elective OR by retroperitoneal approach using straight graft interposition were included. The following perioperative optimisation measures were established in the FT group: No bowel preparation, reduced pre-operative fasting, administration of carbohydrate drink up to 2h before surgery, pain control with pre-peritoneal elastomer, early onset of mobilisation and diet. A comparison was made of the postoperative variables: Postoperative systematic immune response syndrome (SIRS), need for transfusion, stay in resuscitation, hospital stay, and further interventions. ResultsA total of 38 patients were included, with a mean age of 68 years (SD=6.28), of which 97.4% were men. There were 24 patients in control group and 14 in FT group. No statistically significant differences (NSSD) were found in comorbidities of both groups. Mean hospital stay was 6.17 vs. 4.64 days in the FT group, and transfusions were lower in the FT group, with statistically significant differences. Stay in resuscitation unit and re-interventions were also lower in FT group, although NSSD.The incidence of SIRS 48h after surgery in FT group was 21.4% compared to 54.16% in control group (RR=0.38, 95% CI; 0.15 - 0.61). ConclusionsThe FT optimisation measures may reduce the incidence of SIRS, and reduce hospital stay in patients undergoing open repair of AAA.Clinical Research Ethics Committee: AC-11-122.

Neonatal septic arthritis in a tertiary care hospital: a descriptive study.

The study was conducted to evaluate clinical and microbiological profile of neonates with septic arthritis and also to assess changing epidemiology in the microbial etiology. Twenty-nine neonates (1-28days of life) presenting to the Department of Orthopaedics with acute septic arthritis were included in the study. This was a descriptive study, and the data were collected during the time of hospital admission. History and clinical examination of the neonates were taken, and diagnosis was made based on clinical and laboratory parameters. Emergency arthrotomy was performed to prevent catastrophic sequelae in all the cases given antibiotics as per the culture results. Female children predominated in our study. The children were brought to the OPD with an average of 2.7days of fever. Thirty-four joints were involved in 29 neonates, out of whom five had more than one joint involvement. Joint effusion or subperiosteal abscess was found in 22 patients by USG. All children had leukocytosis with neutrophilic predominance. Twenty-one of twenty-nine patients had hip-joint involvement followed by knee in seven patients. Gram-negative organisms had grown more commonly, among which Klebsiella pneumonia was grown in nine patients. Prematurity and anemia still appear to be important risk factors for neonatal septic arthritis. As there is changing trend toward gram-negative infections, attention has to be given toward preventing nosocomial and community-acquired infections. This is very important in premature infants who are susceptible for infection when they are kept in resuscitative units in hospitals.

Accompagnement de l’enfant malade en fin de vie et soutien de sa famille en réanimation pédiatrique en France

The author presents a panorama of the evolution of the reflections and practices at the heart of pediatric resuscitation units both with regards to limitations and stopping of treatment (LAT) and the role of parents in these decisions. Professional recommendations and legal requirements have very likely contributed, but one should not underestimate the importance of ethical reflection carried out by many caring pediatric and neonatal resuscitation teams who were able to benefit from the contribution of parents, child psychiatrists and palliative care professionals. Starting from the idea that this decision was too serious for the families alone, and the need to avoid having them be associated in order to protect them, currently one simply seeks information and collection of the consent or non-opposition of the parents of the sick child with regard to a LAT. This is an uncontested moral and legal requirement, although French legislation has ruled that an LAT decision ultimately rests with the doctor. The recommended attitude towards the parents departs from any systematic approach in order to permit a personalized one, leaving the parents free to choose their level of involvement with regard to the decision of the care team. This is also reflected in the possible presence of parents with their child, a period of reflection (on the order of 24 to 48hours) between the time when the care team makes a collegial decision and the agreement of the parents not to pursue treatment, and the effective switch-off time. This attitude implies a greater team cohesion where nurses and doctors are together with families and children, but it also requires that teams facing such difficult decisions can be assisted.

The Near-Death Experience: A Reality Check?

This paper critically reviews assertions that near-death and out-of-body experiences (ND/OBE) offer proof of extra-corporeal existence when the brain is supposedly “dead”. While this field has almost moved away from mere anecdotal recording, the current trend is focussed on demonstrating existence without functional brains. These endeavours have fallen far short of anticipated results—that cardiac patients would report on strategically-placed markers around acute resuscitation units. Two problems arise: a failure to produce corroborative empirical evidence for extra-corporeal cognition (a) when the brain is “dead”, (or “clinically dead”, so-called) and (b) how the memory required for recall could paradoxically be set down at that critical time-point. The view advanced here is that ND/OBE occur as subjects’ states are returning to complete resumption of conscious-awareness and which, from several published accounts, is particularly abrupt but which nevertheless accounts perfectly for memory—and recall. Similar transcendental adventures accompanying returns to conscious-awareness occur with other preceding states of reduced consciousness. Most recollections are intensely geo-physical, anthropomorphic, banal and illogical: their dream-like fantasy provides nothing revelatory about life without a brain, or importantly, about other supposed cosmic contexts. Additionally, it is proposed that since prevalence rates are so extremely low (<1% globally), the few subjects undergoing ND/OBE may have predisposed brains, genetically, structurally or resulting from previous psychological stress. In a somewhat similar vein to post-traumatic stress disorder, subjects with predisposed brains exhibit markedly changed post-experiential phenotypes, so that the ND/OBE itself could be viewed as a transient, accompanying epiphenomenon.

A FIVE-YEAR EXPERIENCE OF SURGICAL CLOSING A PATENT DUCTUS ARTERIOSIS (PDA) IN PREMA TURE NEONATES

A FIVE-YEAR EXPERIENCE OF SURGICAL CLOSING A PATENT DUCTUS ARTERIOSIS (PDA) IN PREMA TURE NEONATES

Critical Care Resuscitation Unit: An Innovative Solution to Expedite Transfer of Patients with Time-Sensitive Critical Illness

Time-sensitive, critical surgical illnesses require care at specialized centers. Trauma systems facilitate patient transport to designated trauma centers, but formal systems for nontraumatic critical illness do not exist. We created the critical care resuscitation unit to expedite transfers of adult critically ill patients with time-sensitive conditions to a quaternary academic medical center, hypothesizing that this would decrease time to transfer, increase transfer volume, and improve outcomes. Critical care transfers to the University of Maryland Medical Center during the first year of the critical care resuscitation unit (July 2013 to June 2014) were compared with a previous year (July 2011 to June 2012). Times from transfer request to arrival and operating room and hospital mortality were compared. There was a 64.5% increase in transfers with a 93.6% increase in critically ill surgical patients. For patients requiring operation, median time to arrival and operating room (118 vs 223 minutes and 1,113 vs 3,424 minutes, respectively; p < 0.001 for both) and median hospital length of stay (13 vs 17 days; p < 0.001) were reduced significantly. There was a nonsignificant trend toward lower mortality (14.6% vs 16.5%; p= 0.27). The critical care resuscitation unit dramatically increased the volume of critically ill surgical patients. It decreased transfer times, increased volume, and, for those who required urgent operation, decreased time from initial referral to operating room. This benefit seems to be most marked in patients needing urgent operation. This might be a paradigm shift expediting the transfer of patients with time-sensitive critical illness to an appropriately resourced specialty center.

The Analysis of the Risk Factors of Adverse Prognosis of Myocardial Infarction in the Acute Period

The aim was to identify the risk factors contributed to adverse outcome of myocardial infarction (MI) in the acute period of the disease at a prehospital stage. Materials and methods. The study included the call cards of specialized resuscitation and anesthesia units of the budgetary institution A. S. Puchkov «Station of emergency medical care», to patients with complicated MI. The study included two groups of patients. The first group comprized of patients with complicated MI which resulted in circulatory arrest (n=184), the second group (the group of comparison) included patients with com plicated MI without the outcome in circulatory arrest (n=271). Statistical processing of the material: significance of differences between two binomial observations was evaluated by the Barnard's Exact Test. The results of the research. The presence of risk of MI complication as a stopping of blood circulation was confirmed in patients of the age group of 40—60 years (P=0.01). Patients with MI complicated by a circulatory arrest was characterized by a significantly greater intensity of pain syndrome (the pain intensity of 9—10 points was typ ical for 11,2% and 3% of patients of the group with circulatory arrest and the group of comparison, respectively; P&lt; 0.001). The combination of clinical manifestations of alveolar pulmonary edema and arrhythmia occurred in 50% of patients with circulatory arrest, resulted in poor prognosis (the frequency of same parameters in a control group was 28,7%, P=0.018). Tachysystolic arrhythmia was the most common form of alteration at a circulatory arrest. Conclusions. The risk factors for MI adverse outcome in acute period included age from 40 to 60 years, pain of high intensity, presence of cardiogenic shock in combination with alveolar pulmonary edema and tachyarrhythmia.

HOSPITAL INFECTIONS EPIDEMIC IN THE INTENSIVE CARE UNIT OF A GENERAL HOSPITAL

Resuscitation and intensive care units (RICU) of general hospitals are at a high risk of hospital-acquired purulent-septic infections because of the critical conditions of patients and because of the routine use of invasive instruments and antimicrobial preparations. The objective of the present study was to reveal the specific features of the epidemic of hospital-acquired infections in RICU of a general hospital in order to improve preventive interventions. The epidemiological approach used in the study included the prospective analysis of the incidence of purulent-septic conditions among RICU patients. The results included the estimates of the incidences of specific purulent-septic conditions, the identification of their causative agents, and the estimates of time and risk of infecting depending on the duration of patient’s stay in a ward. Measures aimed at ameliorating the epidemiological situation were taken. К. pneumoniae and A. baumannii strains were found to be the most rapidly spreading, compared to other Gram-negative bacteria, among RICU patients.

ORGANIZATIONAL ISSUES OF CARDIOREHABILITATION SERVICE IN RUSSIA. THE RESULTS OF PILOT PROJECT “DEVELOPMENT OF REHABILITATION SYSTEM OF CARDIOVASCULAR PATIENTS IN MEDICAL INSTITUTIONS OF RUSSIAN FEDERATION ENTITIES”

Aim. To analyze, how is, under the framework of the Pilot Project, organized and being conducted the improvement of work of the known departments in exact medical institutions (MI) of RF for rehabilitation of cardiovascular diseases (CVD) patients at the three steps under the current “Order of medical care and medical rehabilitation”, and how do the scientifically proven and types and methods of cardiorehabilitation (CR) being implemented, and to try to elaborate on an exact algorithm for patients course. Material and methods. Into the Pilot Project, 17 MI included, from 13 entities of RF. For the analysis of effectiveness of organizational models of CR in MI the unified charts were developed making to assess the equality to the Order of the rehabilitation care provided to patients with CVD, of multidisciplinary team involved in care, the staff list and MI equipment. Specific charts included the units assessing the efficacy of work on three stages of CR: I stage — in resuscitation and intensive care unit or specialized cardiology department, II — in in-patient department, III — in polyclinics. The article presents data from CR analysis of Jan 2013 to Dec 2015. Results. The CR was organized at the stage I in 10 MI, stage II in 10 MI and stage III in 7 MI. By the year 2015, almost in all MI the multidisciplinary teams were shaped, including cardiologist, cardiorehabilitologist, exercise specialist, clinical psychologist, physiotherapist; the rooms for exercise were equipped, as the halls for education of patients. The start of rehabilitation process from ICU made it to decrease the remaining of patient on the bedside for 0,7 days in average (2013-2015) and for 1 day in cardiovascular department. About 67% myocardial infarction patients in average were transferred to the stage II of CR. In all MI there were educational Schools organized, and the explanatory talks with the relatives were done as well. By now, the project is on its way. Conclusion. The analysis of three-staged CR system for myocardial infarction patients according to current laws, showed significant improvement of rehabilitational activeness of the newly created multidisciplinary teams at all stages of CR, increase of the number of methods of CR and better fulfillment of those, as demonstrated the safety of proposed principals of physical rehabilitation according to the Russian clinical guidelines “Myocardial infarction with ST elevation: rehabilitation and secondary prevention” under the framework of the organizational model of CR.

Опыт применения кишечного лаважа при острых инфекционных заболеваниях у детей в отделении реанимации и интенсивной терапии

Опыт применения кишечного лаважа при острых инфекционных заболеваниях у детей в отделении реанимации и интенсивной терапии

ANTIMICROBIAL THERAPY OF PATIENTS WITH FAN-ASSOCIATED PNEUMONIA: FOCUS ON DOPIRENEM

The fan-associated pneumonia currently is a leading reason of mortality of patients in resuscitation and intensive care unit. Development of the disease is accompanied by serious clinical and economic consequences. The adequate antibacterial therapy plays the determining role in the favorable outcome in pneumonia. Doripemen is a new parenteral 1-beta-methyl-carbapenem that was launched into the pharmaceutical market of Russia in 2008. The purpose of this review is to generalize the results accumulated to this moment on effectiveness of doripenem in therapy of fan-associated pneumonia.

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Purpose. To make a comparative evaluation of Dexmedetomidine and Midazolam sedative effect in children with cerebral palsy (CP) in the early postoperative period in Resuscitation and Intensive Care Unit (RICU) after performing multilevel acute interventions accompanied by reconstructive procedures of the hip. Materials and Methods. We made a comparative evaluation of the effectiveness of sedation with Dexmedetomidine and Midazolam in 14 children with CP in the early postoperative period after multilevel acute surgical orthopedic interventions who divided into three comparable groups. Ramsay Scale, Scale of Excitement Evaluation – Richmond sedation used in order to evaluate sedation level. Postoperative analgesia in all the groups performed by 0.2 % Ropivacaine infusion into the epidural space using a previously set epidural catheter. Results. As demonstrated, the children in the Group 1 (without sedation) were excited, anxious, they felt uncomfortable. In Groups 2 (sedation with Dexmedetomidine) and 3 (sedation with Midazolam) the level of sedation was significantly higher than in the control group, it attained light and moderate levels. Conclusion. Thus, Dexmedetomidine and Midazolam appeared to be effective preparations to sedate the children with CP staying in RICU in the early postoperative period, and no significant

Abstract: Training of Advanced Cardiac Life Support Skills to Nursing Staff in Critical Areas of Care

Background: This advanced cardiac life support skills (ACLS) program was free of charge and the program was coordinated in collaboration with resuscitation service, unit managers and clinical mentors. Prior to ACLS certification, classes of Basic Life Support (BLS) were held every week for the staff nurses at King Faisal Hospital. Objectives: The purpose of this innovation was threefold, to: 1.Improve outcomes of patients requiring resuscitation through the education of nurses; 2. Meet the hospital accreditation standards in critical areas. 3. Build a sustainable program by educating instructors about local BLS and Advanced Cardiac Life Support (ACLS) in King Faisal Hospital. Description: This ACLS program was free of charge and coordinated in collaboration with unit managers and clinical mentors. Prior to ACLS certification classes, the BLS classes were held every week for the staff nurses at King Faisal Hospital. The BLS instructors were American Heart Association certified (AHA) instructors; clinical mentors from the Human Resources for Health (HRH) program and hospital staff members working together using the standards of the American Heart Association certifying 200 BLS nurses. Nurses from critical areas such as intensive care, emergency department and the operating theatre were chosen to complete the ACLS certification, consequently 80 nurses became ACLS certified and 6 nurses completed ACLS instructors training. Results: Statistics from March 2014 indicated the survival rate following resuscitation efforts was 34% and by October 2014 the survival rate had risen to 52%. Lessons Learned: This educational innovation represents a very positive collaboration between stakeholders in addressing the need for capacity building related to cardiac life support in Rwanda. Ideally there needs to exist continued educational opportunities with ACLS recertification and continued resuscitation review to maintain the high quality standards initiated with this program. Conclusions: This intervention showed an obvious positive impact on health care delivery system at King Faisal Hospital, with a significant increase in the number of survivors due to earlier intervention and the skills learned at the ACLS program. All three of the preliminary purposes of the program were met. Our future goals include becoming the educational Centre for Rwanda in Advanced Cardiac Life Support. Keywords: advanced cardiac life support, basic life support, human resources for health, American heart association

50th anniversary of the Resuscitation and Anesthesiology Unit, Sverdlovsk Regional Clinical Hospital

50 th anniversary of the Resuscitation and Anesthesiology Unit, Sverdlovsk Regional Clinical Hospital

Hemoglobin-oriented and coagulation factor-based algorithm : Effect on transfusion needs and standardized mortality rate in massively transfused trauma patients

Bleeding and trauma-induced coagulopathy (TIC) are major contributors to death related to trauma in the first 24 h and the major preventable contributors. Early surgical therapy and aggressive correction of TIC are key steps to prevent death in patients suffering from hemorrhage. Therefore, a standard operating procedure (SOP) using a hemoglobin (Hb)-oriented and coagulation factor-based algorithm for early correction of TIC was introduced in this level 1 trauma center. This SOP uses the correlation of the Hb values measured in the trauma bay and standard coagulation tests as the basis for various aggressive coagulation therapies. The aim was to investigate the effectiveness of the SOP in trauma patients requiring massive transfusions. The main objective was the effect on the transfusion requirements and the standardized mortality ratio (SMR), the ratio of observed deaths to expected/predicted deaths, in the cohort of massively transfused trauma patients after introduction of the SOP compared with a historical cohort. A retrospective, single center study was carried out at a supraregional trauma center between 2005 and 2014. After introduction of the Hb-oriented, coagulation factor-based SOP for correction of TIC in 2011 a before/after comparison of all trauma patients requiring massive transfusions during trauma bay resuscitation and intensive care unit (ICU) admission was carried out. Main outcome parameters were the transfusion requirement and the SMR. The historical cohort of massively transfused trauma patients before introduction of the SOP (group 1) was compared with the cohort after introduction of the SOP (group 2). Furthermore, the two cohorts were compared regarding injury severity, expected death calculated with the revised injury severity classification (RISC), hemostatic results on trauma bay and ICU admission, clotting therapy and outcome. Of the 952 patients investigated 86 (9%) required massive transfusion (45 in group 1 and 41 in group 2). Both groups were comparable regarding injury severity but showed slight differences in hemostatic results on trauma bay admission, with a trend to worse results in group 2. Differences were recorded for platelet count on trauma bay admission with significantly lower values in group 2. The RISC predicted a significant difference in the mortality rate (46.5% group 1 and 65.3% group 2) but no significant differences in the observed mortality (44.4% group 1 and 47% group 2) were recorded. The SMR decreased from 0.95 in group 1 to 0.72 in group 2, meaning that in group 1 from 21 predicated trauma deaths 20 occurred and in group 2 from 27 predicated trauma deaths 19 occurred. This difference is not statistically significant (p = 0.16) due to the small sample size but is clinically relevant. A significant reduction in the requirement of red blood cell transfusions (22.8 ± 8.1 units vs 17.6 ± 7.6 units) was achieved (p = 0.003). Significant differences between the groups were observed regarding frequency and quantity of the coagulation-promoting drugs. Compared with group 1 the SOP used in group 2 achieved significantly better hemostatic results on ICU admission for fibrinogen and Quick's value and a clear trend to better results for international normalized ratio (INR) and PTT. The SOP based on coagulation factor values and standardized clotting therapy showed a clear trend to reduction of the SMR in massively transfused trauma patients. On the other hand the SOP achieved a significant reduction in the transfusion requirements and a significant improvement in the hemostatic results in the most severely injured patients. This can be interpreted as an effective use of coagulation factors in the early hospital treatment of trauma patients with ongoing bleeding.