Outcome Evaluation of Massive Transfusion Protocol in Emergency Departments, Hospital Putrajaya and Hospital Ampang: A 3-year Retrospective Study
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Abstract
Introduction: Massive Transfusion Protocol (MTP) is a rapid administration of large amount of blood product at a fixed ratio of 1:1:1 of fresh frozen plasma (FFP), platelets (PLT) and a PRBC. The primary objective for this study was to evaluate the transfusion delivery time (TDT), mortality and length of hospital stay (LOS) between patients with and without MTP activation. Materials and Methods: This is a retrospective cohort study of 253 trauma and non-trauma patients who underwent blood transfusion in the emergency departments (ED) of Hospital Putrajaya and Hospital Ampang from January 2017 until December 2019. Groups comparison was conducted between patients with the MTP and non-MTP groups, and trauma and non-trauma groups. Data was obtained from patient's electronic medical record. Results: MTP was activated in 49 patients. The prevalence of MTP was higher in trauma patients compared to non-trauma. MTP resulted in shorter TDT and reduced 24-hour mortality in all patients receiving blood transfusion in ED. There were no significant association between MTP activation and LOS, and mortality reduction in the trauma and non-trauma groups. No data on transfusion error was obtained. Conclusion: This study demonstrated a significant association between MTP and improved patient’s outcome by reducing TDT and 24-hour mortality in all patients who received blood transfusion in ED. The findings of this study can be utilised for the development of national MTP clinical practice guideline (CPG).
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Patil V, Shetmahajan M. Massive transfusion and massive transfusion protocol. Indian J Anaest. Sep-Oct 2014; 58(5):590-595. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC4260305/
Wijaya C, Cheng H, Chong C. The use of massive transfusion protocol for trauma and non trauma patients in a civilian setting: What can be done better? Singapore Med J 2016; 57(5): 238-241. Available from: https://pubmed.ncbi.nlm.nih.gov/27211577/
Greer SE, Rhynhart KK, Gupta R, Corwin HL.New developments in massive transfusion in trauma. Curr Opin Anaesthesiol, Apr 2010;23:246-250. doi: 10.1097/ACO.0b013e328336ea59
British Committee for Standards in Haematology Stains by D, MacLennan S, et al. Guidelines on the management of massive blood loss. British Journal of Haematology. Dec 2006;135:634-41. doi: 10.1111/j.1365-2141.2006.06355.x
Hsu Y, Haas T, Cushing M. Massive transfusion protocols: Current best practice. International Journal of Transfusion Medicine, March 2016; 2016(4): 15-27. doi: https://doi.org/10.2147/IJCTM.S61916
Transfusion Error Surveillance System (TESS) 2012-2013 Report, Public Health Agency of Canada, Ontario: July 2016; 4. Available from: https://www.canada.ca/en/public-health/services/publications/drugs-health-products/transfusion-error-surveillance-system-tess-2012-2013-report.html
Broxton S, Medeiros R, Abuzeid A, Peterson C, Schumacher A. Implementation of a Massive Transfusion Protocol: Evaluation of Its Use and Efficacy. Journal of Trauma Nursing, March 2018; 25 (2): 92-97. doi: 10.1097/JTN.0000000000000350
Hwang, K., Kwon, J., Cho, J., Heo, Y., Lee, J. C.-J., & Jung, K. Implementation of Trauma Center and Massive Transfusion Protocol Improves Outcomes for Major Trauma Patients: A Study at a Single Institution in Korea. World Journal of Surgery, Oct 2017, 42(7), 2067–2075. Available from: https://onlinelibrary.wiley.com/doi/10.1007/s00268-017-4441-5
Maciel JD, Gifford E, Plurad D, de Virgilio C, Bricker S, Bongard F, Neville A, Smith J, Putnam B, Kim D. The impact of a massive transfusion protocol on outcomes among patients with abdominal aortic injuries. Ann Vasc Surg. 2015;29(4):764-9. doi 10.1016/j.avsg.2014.11.024.
Martinez-Calle N, Hidalgo F, Alfonso A, Munoz M, Hernandez M, Lecumberri R, Paramo J, Implementation of a management protocol for massive bleeding reduces mortality in non-trauma patients: Results from a single centre audit. Medicina Intensiva, December 2016 ; Vol 40 (9): 550-559. Available from: https://www.sciencedirect.com/science/article/abs/pii/S0210569116300973
Gigervis R, Munnagi S, M Fomani K, Boutin A, Zapata L, Angus G. Evaluation of massive transfusion protocol practices by type of trauma at a Level 1 trauma centre. Chinese Journal of Traumatology, Oct 2018; Vol 1(5): 261-266. doi 10.1016/j.cjtee.2018.01.005.
Holcomb J, del Junco D, Fox E. The Prospective, Observational, Multicenter, Major Trauma Transfusion (PROMMT) Study - Comparative Effectiveness of a Time-Varying Treatment with Competing Risk. JAMA Surgery, 2013 ;148(2):127-136. Available from: https://jamanetwork.com/journals/jamasurgery/fullarticle/1379768
Wan Zulkipli N, Mangantig M, Hassan MN, Fauzi HM. Study on Practice of Massive Transfusion Protocol Activation in Hospital Universiti Sains Malaysia, Special Issue, 2022, Journal of Health and Translational Medicine 2022: 1. doi: https://doi.org/10.22452/jummec.sp2022no1.21
ACS TQIP Massive Transfusion Guideline, American College of Surgeons, Oct 2014. Available from: https://www.facs.org/media/zcjdtrd1/transfusion_guildelines.pdf
Meyer D, Vincent L, Fox E, O'Keffe T, Inaba K, Bulger E, Holcomb J, Cotton B. Every minute counts: Time to delivery of initial massive transfusion cooler and its impact on mortality. Journal Trauma Acute Care Surgery, Jul 2017; 83(1):19-24, doi: 10.1097/TA.0000000000001531
Ram P, Paul C, Grant C, Yamini P, Kenra F, Coritsidis G. 1507: Massive transfusion activation in non-trauma patients at urban level-1 trauma centres. Critical Care Medicine, January 2020; 48(1):729. doi: 10.1097/01.ccm.0000647936.58176.81
Pham HP, Shaz BH. Update on massive transfusion. British Journal of Anaesthesia, 2013; 111(1): 71-82. doi: 10.1093/bja/aet376
Consunji R, Elseed A, El-Menyar A, Sathian B, Rizoli S, Al-Thani H, Peralta R, The Effect of Massive Transfusion Protocol Implementation on the Survival of Trauma patients: A systematic review and meta-analysis. Blood Transfusion,18 Sept 2020;18(6):434-445. doi: 10.2450/2020.0065-20
Yoon KW, Cho D, Lee DS, Gil E, Yoo K, Choi KJ, Park CM, Clinical impact of massive transfusion protocol in non-traumatic patients. Transfusion and Apheresis Science, Feb 2020; 5(1) doi: https://doi.org/10.1016/j.transci.2019.07.007
Holcomb JB et al. Transfusion of Plasma, Platelets, and Red Blood Cells in a 1:1:1 vs a 1:1:2 ratio and Mortality in Patients with Severe Trauma: The PROPPR Randomized Clinical Trial. JAMA, Feb 2015, 3;313(5):471-82. doi: 10.1001/jama.2015.12.
Sommer N, Schruriger B, Candinas D, Haltmeier T. Massive transfusion protocols in non trauma patients: A systematic review and meta-analysis. J Trauma Acute Care Surg, March 2019; 86(3): 493 – 504. doi: 10.1097/TA.0000000000002101
Van Der Meij J, Geeraedts Jr LMG, Kamphuis SJM, Kumar N, Greenfield T, Tweedale G, Rosenfled D, Amour SKD, Ten-year evolution of Massive Transfusion Protocol in level 1 Trauma Centre: Have outcomes improved? ANZ Journal of Surgery, 9 Sept 2019, 89(11): 1470-1474. doi: 10.1111/ans.15416.
Nunn A, Fischer P, Sing R, Templin M, Avery M, Christmas A, Improvement and Treatment outcomes after implementation of Massive Transfusion Protocol: A Level 1 Trauma Centre Experience. Am Surg, 1 Apr 2017;83(4):394-398. Available from: https://journals.sagepub.com/doi/10.1177/000313481708300429
Subramaniam A, Albert V, Sharma S, Kondru S, Pandey R. Assessing the efficiency of scoring system for predicting the probability of massive transfusion in trauma patients. Journal of Haematology and Thromboembolic Disease, September 2014; 2(5): 1-6. doi: 10.4172/2329-8790.1000161
Maegele M. Transfusion Medicine and Hemotherapy. Mar 2012; 39: 85-97. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC3364090/
Nunez T, Voskrensky I, Dossett L, Shinall R, Dutton W, Cotton B. Early prediction of massive transfusion in trauma: simple as ABC (assessment of blood consumption)? J. Trauma, Feb 2009; 66(2):346-352. doi: 10.1097/TA.0b013e3181961c35.
Guidelines for the rational use of blood and blood products, National Blood Centre, Ministry of Health Malaysia, 2017. Available from: https://pdn.gov.my/v2/images/dokumen/ebook_blood_transfusion_guideline.pdf
Guidelines for Massive Transfusion Protocol, Hospital Ampang, 2017. Available from: https://jknselangor.moh.gov.my/hampg/images/DokumenJabatan/Hematologi/4th_Edn_MRKH_HANDBOOK_v4.0_Amend_0.0_31-August-2022_compressed.pdf
Guidelines for Massive Transfusion Protocol, Hospital Putrajaya, 2017. Available from: https://pdn.gov.my/v2/images/dokumen/2024/Consensus_Statement_on_Patient_Blood_Management.pdf
Kori, Ahlam Naira. Massive Transfusion Protocol. Hospital Temerloh, 10 Oct 2015. Available from: https://pdn.gov.my/v2/images/dokumen/HANDBOOK_ON_CLINICAL_USE_OF_BLOOD_v2.021.10.2020.pdf
Guidelines for massive blood transfusion. Hospital Canselor Tuanku Muhriz, 2016; 1. Available from: https://hctm.ukm.my/makmal/wp-content/uploads/2020/10/3-Massive-Blood-Transfusion-Protocol-PPUKM-Final-1.pdf
Krejcie Robert M, Morgan Daryle. Educational and Psychological Measurement. 1970, 30: 607-610., Available from: file:///C:/Users/Win10/Downloads/DETERMINING_SAMPLE_SIZE_FOR_RESEARCH5b15d%20(1).pdf
Maegele, Marc. Challenges to improving patient outcome following massive transfusion in severe trauma. Expert Review of Haematology, 19 Feb 2020; 13(4): 323-330. doi: 10.1080/17474086.2020.1733404
Sihler K, Napolitano L, Complications of massive transfusion. Chest, Jan 2010; 137 (1): 209-220. doi: 10.1378/chest.09-0252