Effect of Pre-Hospital Use of the Assessment of Blood Consumption Score and Pre-Thawed Fresh Frozen Plasma on Resuscitation and Trauma Mortality
| Autor: | Regina V. Krell, Franklin L. Wright, Stephanie Vega, Catherine G. Velopulos, Erik D. Peltz, Robert C. McIntyre, Lisa Ferrigno, Alicia A. Heelan Gladden |
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| Rok vydání: | 2019 |
| Předmět: |
Adult
Male Resuscitation medicine.medical_specialty Blood Component Transfusion Hemorrhage 030230 surgery Plasma 03 medical and health sciences Injury Severity Score 0302 clinical medicine Clinical Protocols Trauma Centers Blood product Humans Medicine Retrospective Studies business.industry Retrospective cohort study Emergency department Middle Aged medicine.disease Quality Improvement Outcome and Process Assessment Health Care 030220 oncology & carcinogenesis Emergency medicine Wounds and Injuries Female Surgery Fresh frozen plasma Triage business Packed red blood cells Penetrating trauma |
| Zdroj: | Journal of the American College of Surgeons. 228:141-147 |
| ISSN: | 1072-7515 |
| DOI: | 10.1016/j.jamcollsurg.2018.11.005 |
| Popis: | Background Early blood product resuscitation reduces trauma patient mortality from hemorrhage. This mortality benefit depends on a system that can rapidly identify actively bleeding patients, initiate massive transfusion protocol (MTP), and mobilize resources to the bedside. We hypothesized that process improvement efforts that identify patients early and mobilize appropriate blood products to the bedside for immediate use would improve mortality. Study Design Pre-implementation, MTP activation was at the discretion of the trauma surgeon, and only PRBCs were immediately available. In June 2016, the Assessment of Blood Consumption (ABC) score was incorporated in our pre-hospital triage process, and a process for thawed plasma to be available was developed. We performed a retrospective review of patients who were hypotensive on arrival or had MTP activated. We compared mortality and MTP component ratios 15 months pre- vs 15 months post-implementation. Results Activations of MTP increased 6-fold, while the specificity of the process remained the same. In patients receiving MTP, appropriate blood product transfusion ratios increased 44%. Overall and penetrating trauma mortality improved by 23% and 41%, respectively. When divided by the Injury Severity Score (ISS), penetrating trauma mortality decreased by 65% for the ISS subgroup 15 to 24 and by 38% for ISS subgroup ≥ 25. Length of stay, ICU length of stay, and readmission rates were not significantly different. Conclusions Delivery of balanced blood product resuscitation is essential to confer mortality benefits. Process improvement directed at early recognition of the hemorrhagic patient, immediate product availability, and product delivery to the bedside for transfusion allows for mortality reduction without increased resource use. |
| Databáze: | OpenAIRE |
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