Evolution of Practices in a French Trauma Centre: Decrease in Blood Transfusions and Fresh Frozen Plasma to Red Blood...

Area of Science:

• Trauma Resuscitation
• Transfusion Medicine
• Hemorrhage Control

Background:

• Trauma resuscitation units (TRUs) face challenges in optimizing blood product transfusion protocols.
• The introduction of viscoelastic hemostatic assays and antifibrinolytic agents has influenced transfusion strategies.

Purpose of the Study:

• To analyze the evolution of transfusion practices in a French teaching hospital's TRU after implementing tranexamic acid (TXA) and ROTEM analysis.
• To assess changes in red blood cell (RBC) and fresh frozen plasma (FFP) utilization and ratios.

Main Methods:

• Retrospective analysis of 122 trauma patients transfused with ≥4 RBCs within 24 hours (2011-2016).
• Evaluation of transfusion practices, FFP:RBC ratios, and administration of fibrinogen and TXA over time.

Main Results:

• Significant decrease in patients requiring ≥4 RBCs (9% to 3%) and high FFP:RBC ratios (86% to 62% at 6 hours, 86% to 56% at 24 hours).
• Systematic administration of TXA (100%) and increased fibrinogen use (>70%) after 2013.
• Observed mortality was lower than predicted, independent of FFP:RBC ratio.

Conclusions:

• Transfusion practices evolved significantly, with reduced RBC transfusions and lower FFP:RBC ratios.
• Multifactorial changes likely driven by systematic TXA use and optimized ROTEM-guided fibrinogen administration.
• These practice changes correlated with improved patient outcomes in trauma resuscitation.