Massive transfusion protocol in adult trauma population.

Area of Science:

• Emergency Medicine
• Trauma Surgery
• Hemorrhage Control

Background:

• Acute blood loss in trauma necessitates rapid volume restoration.
• Massive Transfusion Protocols (MTPs) are critical in Trauma Centers for timely blood product delivery.
• This review examines current MTP transfusion ratios and adjuncts.

Purpose of the Study:

• To review current standards for transfusion ratios in MTPs.
• To explore adjuncts used during massive transfusions.
• To assess the impact of MTPs on trauma patient outcomes.

Main Methods:

• A literature search of PubMed (2005-2020) was conducted for MTPs.
• Articles were evaluated based on study design, injury mechanism, MTP type, timing of administration, pre-hospital treatment, and outcomes.
• Key findings on transfusion ratios, timing, and adjuncts were synthesized.

Main Results:

• Eleven studies analyzed transfusion ratios, with evidence supporting balanced ratios (1:1:1) confirmed by the PROPPR trial.
• Seven studies highlighted improved outcomes with earlier blood product administration.
• Nine studies discussed pre-hospital treatment and adjuncts, noting advancements in coagulation monitoring.

Conclusions:

• Current MTPs should employ 1:1:1 to 1:1:2 ratios of plasma, platelets, and red blood cells.
• MTPs are effective in reducing mortality.
• Prompt availability and administration of blood products in the trauma bay are crucial for better patient outcomes.