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Massive transfusion protocols in the Netherlands. Consensus or confusion?

Tim W H Rijnhout1, Femke Noorman2, Oscar J F van Waes3

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Knowledge of massive transfusion protocols (MTP) and transfusion strategies among trauma physicians in the Netherlands is low. Few physicians know the exact MTP composition, and there is little consensus on transfusion indications, impacting patient care.

Keywords:
BleedingDamage control resuscitationHaemorrhageMassive transfusionMassive transfusion protocolPlateletsResuscitationShockTrauma

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Area of Science:

  • Trauma surgery
  • Critical care medicine
  • Transfusion medicine

Background:

  • Massive transfusion protocols (MTP) are crucial for managing trauma patients with massive hemorrhage.
  • Effective MTP implementation improves patient outcomes, yet knowledge gaps persist.
  • This study investigates MTP knowledge and transfusion strategies in Dutch Level 1 trauma centers.

Purpose of the Study:

  • To assess the current knowledge of local massive transfusion protocols (MTP) among healthcare professionals in Dutch Level 1 trauma centers.
  • To evaluate the existing transfusion strategies employed in managing massive hemorrhage in trauma patients.
  • To identify potential discrepancies in MTP knowledge and transfusion practices.

Main Methods:

  • Surveys were distributed to trauma surgeons, anesthesiologists, and emergency physicians in Dutch Level 1 trauma centers.
  • Respondents were categorized into frequent (≥4 MTP uses/year) and non-frequent (<4 MTP uses/year) users.
  • Data on MTP knowledge, transfusion sequence, and indications were collected and analyzed.

Main Results:

  • Low awareness of local MTP composition was reported by 27% of local respondents.
  • A consistent transfusion sequence (erythrocytes, then plasma and platelets) was favored by over 90% of respondents.
  • Platelet transfusion indications varied, with few relying on platelet counts; viscoelastic assays were primarily used by frequent MTP users.

Conclusions:

  • A significant majority of physicians involved in massive transfusions lack awareness of their institution's MTP specifics.
  • There is a notable lack of consensus regarding optimal transfusion strategies and specific indications for platelet transfusion.
  • Findings highlight the need for improved education and standardization of MTP knowledge and practice in trauma care.