Emergency red cells first: Rapid response or speed bump? The evolution of a massive transfusion protocol for XXXX in a single UK centre.

@entity1 @entity25341 @entity548 @entity1358 @entity130
BACKGROUND: Death from massive @entity548 due to @entity130 is potentially preventable after hospital admission using @entity548 control and improved resuscitation techniques including massive transfusion protocols. Massive transfusion protocols (MTP) are an essential element of damage control resuscitation and provide a coordinated clinical pathology response to massive @entity548 after hospital admission. The decision to activate and de-activate a MTP is based on a number of @entity1 and local factors. The purpose of this before-and-after study was to determine the impact of modifying a protocol to include emergency red cells. In addition, we investigated whether massive transfusion prediction models could have been used to guide on-going transfusion support. METHODS: Sequential MTP activations over three years, before and after protocol revision, were analysed. Percentage of MTP activation, component usage and outcome data were compared. @entity130 associated severe @entity548 (TASH) and assessment of blood consumption (ABC) scores were derived and receiver operating characteristic (ROC) analysis undertaken for an outcome defined as the use of >6 red cell units. RESULTS: 52 @entity25341 and 66 MTP2 activations arose from 216 and 495 major @entity130 cases, respectively. Protocol change significantly reduced the MTP activation rate (p=0.0006) from 24% to 13%, and the number of activations requiring >10 @entity1358 increased from 13% to 36% (p=0.006). Average emergency red cells usage in the second cohort increased to 4 units. Survival, coagulation parameters, and time to MTP pack issue were all unaffected by the protocol revision. The TASH score showed an area under ROC (AUROC) of 0.88 ongoing transfusion requirements. CONCLUSION: The change in protocol increased the use of emergency red cells but reduced MTP activation and use of multiple blood components. The TASH score appears to provide a useful predictive tool for ongoing transfusion support and may be of value for the @entity130 clinicians.
