This is based on my interpretation of the Pragmatic, Randomized Optimal Platelet and Plasma Ratios (PROPPR) trial, which found no significant mortality difference at one or 30 days between those patients who received a 1:1:1 ratio versus a 2:1:1 ratio. 7 I recommend a 2:1:1 ratio of red cells to plasma to platelets. Resuscitation intensity has been suggested as a trigger specifically, if there has been a requirement of three units of any combination of crystalloids or blood products to maintain adequate tissue perfusion, we might call this an “intense” resuscitation. The third time period to consider activation of an MHP is during resuscitation. Pitfall conditions that may lower the threshold for activating an MHP include those patients who are elderly, those taking anticoagulant medications or dual antiplatelet therapy, and those taking medications that may blunt hemodynamic response to hemorrhage such as a beta blockers. 6 RABT assigns one point each for shock index >1, pelvic fracture, positive Focused Assessment with Sonography for Trauma (FAST), and penetrating injury. A Revised Assessment of Bleeding and Transfusion (RABT) score ≥2 has been shown to be more accurate than the Airway, Breathing, and Circulation (ABC) score in predicting the need for massive transfusion. When the patient arrives to the trauma bay, clinical judgment, clinical decision tools, and pitfall conditions should be considered. During the prehospital period, a concerning mechanism of injury such as a fall from three stories or a shock index (heart rate/systolic blood pressure) ≥1 should trigger the consideration for an MHP activation. Nonetheless, there are three time periods during which activation of an MHP should be considered: prehospital, ED arrival, and intra-resuscitation. There is no one clinical or laboratory finding that accurately predicts the need to activate an MHP.
The decision to activate an MHP should be guided by clinical judgment, decision tools, and response to early management. MHP places the emphasis on the early, timely administration of blood products, ancillary medications such as tranexamic acid, precise clinical and laboratory monitoring and targets, temperature control, and hemorrhage control.
#Massive transfusion protocol series#
We also have to initiate a series of adjacent and often crucial actions simultaneously. This definition, however, is inadequate for short ED stays. Historically, the definition of massive transfusion protocol is the administration of 10 units of red cells over 24 hours.
REBOA may Be Helpful for Some Trauma Patients with Massive BleedingĮxplore This Issue ACEP Now: Vol 40 – No 05 – May 2021.Time-to-Hospital May Be Key to Disparate Results in Studies on Pre-Hospital Plasma Administration.
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