Massive Transfusion Activations in Non-Trauma Patients.

Area of Science:

• Emergency Medicine
• Critical Care
• Transfusion Medicine

Background:

• Massive transfusion activations (MTAs) are a critical intervention in trauma care.
• MTAs in non-trauma patients represent a significant portion of activations at tertiary hospitals.
• Characterizing MTA practices in non-trauma settings is essential for optimizing patient management.

Purpose of the Study:

• To analyze the characteristics and utilization of massive transfusion activations in a non-trauma patient population.
• To identify patterns in transfusion ratios, adjunctive therapies, and diagnostic tools used during MTAs.
• To provide insights into current practices for potential improvements in non-trauma critical care.

Main Methods:

• Retrospective review of all non-trauma MTAs from January 2017 to April 2019.
• Exclusion of cases with unclear indications for MTA.
• Data collection included demographics, indication for MTA, transfusion ratios, antifibrinolytics, viscoelastic testing, and vasopressor use.

Main Results:

• 353 MTAs in 328 non-trauma patients were analyzed (mean age 52.0 years, 40.9% male).
• Medical services accounted for the majority of MTAs (55.2%), followed by obstetrics (25.3%) and surgery (19.5%).
• Low adherence to 1:1:1 transfusion ratios (56.1% mortality), high vasopressor use (70.8%), and low utilization of antifibrinolytics (13.0%) and viscoelastic testing (19.0%) were observed.

Conclusions:

• Massive transfusion activations are frequently employed in non-trauma patients.
• Current practices show low adherence to recommended transfusion ratios and limited use of adjuncts for targeted resuscitation.
• Further understanding and optimization of MTA protocols in non-trauma settings are warranted to improve outcomes.