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Massive Transfusion Protocol in Hemorrhagic Shock: A Retrospective Analysis

This retrospective study analyzes the massive transfusion practices and outcomes in non-trauma-related hemorrhagic shock at a tertiary care center. The study covers a two-year period, focusing on patient survival and factors such as demographics, comorbidities, surgical details, and laboratory parameters. Results from 2,800 cases reveal insights into blood component transfusion ratios, ICU stays, and postoperative recovery. The study highlights the need for an effective massive transfusion protocol to improve patient survival rates, emphasizing collaboration between healthcare teams. Limitations include insufficient TEG reporting and missed D-Dimer investigations. References cited offer insights into optimizing transfusion practices in various medical settings.

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Massive Transfusion Protocol in Hemorrhagic Shock: A Retrospective Analysis

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  1. Dr. Gayathri.A.M, Dr.S.Sathyabhama, Dr.Debasish Gupta Department of Transfusion Medicine, SCTIMST,Trivandrum RETROSPECTIVE ANALYSIS OF MASSIVE TRANSFUSION PRACTICE IN NON-TRAUMA RELATED HEMORRHAGIC SHOCK IN A TERTIARY CARE CENTRE

  2. MASSIVE TRANSFUSION

  3. MAXIMUM SURGICAL BLOOD ORDER SCHEDULE (MSBOS) DESIGNED FOR OUR INSTITUTE NEUROSURGERY CASES CARDIOTHORACIC CASES

  4. MASSIVE TRANSFUSION PROTOCOL OF OUR INSTITUTE >40 Kg BODY WEIGHT < 5 Kg BODY WEIGHT 5- 15 Kg BODY WEIGHT 15-40 Kg BODY WEIGHT

  5. AIMS & OBJECTIVES MATERIALS AND METHODS • To analyse retrospectively the massive transfusion practices and resultant outcome of patients over a period of two years • This is a retrospective observational study of all patients who received a massive transfusion for non-traumatic hemorrhagic shock over a two-year period (2016-2017) • The primary outcome was in-patient hospital survival • Electronic medical records of 53 non-traumatic patients including both adult and paediatric cases that were admitted and had massive transfusion were assessed

  6. Variables include : • Age • Sex • Body weight • Co-morbidities • Drug history • Diagnosis and nature of surgical procedure • Pre-surgical laboratory investigations (Hb, PCV, platelet counts, PT/INR, aPTT, potassium, BUN) & post surgical laboratory parameters • Ratio of blood components transfused • Period of ICU, Ventilator, Extra-corporeal membrane oxygenator and hospital stay • Recovery index

  7. RESULTS 2800 TOTAL CASES SINCE 2 YEARS 1450 TOTAL CASES: 6750 0.78% GENDERSCORE

  8. DIAGNOSIS PROCEDURE

  9. PRE- SURGICAL DRUG INTAKE ASSOCIATED CO-MORBIDITIES

  10. DURATION OF HOSPITAL STAY, ICU STAY & VENTILLATOR STAY DISTRIBUTION OF WEIGHT IN ALL CASES NO. OF PATIENTS

  11. INTRA & POST OPERATIVE BLOOD USAGE ADULT PAEDIATRIC

  12. PRE & POST SURGICAL INVESTIGATIONCOMPARISON p value 15.9 3.83 2.01 1.6 26.13 2.28 31.07 38.32 10.6 13.1

  13. OUTCOME FOLLOWING MASSIVE TRANSFUSION

  14. CARDIOTHORACIC SURGERY (n=12) Post op cardiac tamponade (3 cases) NEUROSURGERY (n=2) MORTALITY ANALYSIS On table: Acute uncontrolled bleed in ruptured TAAA (2 cases) CKD on Dialysis (1 case) Ruptured multiple Intra cranial Aneurysm Poor preoperative anticoagulation management and multiple comorbidities (6 cases)

  15. OBSERVATIONS • All paediatric cases survived after appropriate massive transfusion protocol • Potassium and BUN in all scenarios • Hb, PCV, Platelet counts, PT & APTT in expired cases Statistically insignificant

  16. CONCLUSION • A good massive transfusion protocol is required to increase the patient survival rates • Good orchestration between clinicians, anaesthesiologist and blood center team • Appropriate utilisation of blood units • Turn around time should be reduced

  17. LIMITATIONS • TEG reporting were insufficient to do analysis • Baseline D-Dimer investigation not performed

  18. REFERENCES • Kevin M S, Kimberly A D, Felix Y L et al. The status of massive transfusion protocols in United States trauma centers: massive transfusion or massive confusion? Transfusion 2010;50:1545-51.258 • Norgaard A, Stensballe J, de Lichtenberg T H,et al. Three-year follow-up of implementation of evidence-based transfusion practice in a tertiary hospital. Vox Sang. 2017;112:229-397 1 • Shahram P, Hosseinali K, Golnar S, et al.Comparison of the impact of applications of Targeted Transfusion Protocol and Massive Transfusion Protocol in trauma patients. Korean J Anesthesiol 2017; 70: 626-32 • Keyvan K, Rachel O, Terrence M Y, et al. Prediction of massive blood transfusion in cardiac surgery. CAN J ANESTH 2006 ;53:781–94 • Zoe K M, Gemma C, Susan B, et al. Optimal Dose, Timing and Ratio of Blood Products in Massive Transfusion: Results from a Systematic Review. Transfus Med Rev. 2018;32(1):6-15

  19. THANKYOU

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