Allcock E C, Woolley T, Doughty H, Midwinter M, Mahoney P F, Mackenzie I
ST6 Anaesthetics & ICU, Institute of Naval Medicine, Gosport, Hants.
J R Army Med Corps. 2011 Dec;157(4):365-9. doi: 10.1136/jramc-157-04-03.
The UK Defence Medical Services has developed a Massive Transfusion Protocol (MTP) that forms part of the initial Damage Control Resuscitation process for severely injured combat casualties. The key objectives of this retrospective review of MTP recipients are to document the survival rates, level of critical care support required and the blood components transfused as part of the Massive Transfusion Protocol in Afghanistan during 2009. In addition to providing a measure of our current effectiveness it should also provide a reference point for future reviews as the MTP continues to evolve.
This was a collaborative project involving the Royal Centre for Defence Medicine and the Critical Care Department, University Hospitals Birmingham. It was limited to UK military personnel who were injured in 2009 and received massive transfusions (defined as the transfusion of 10 or more units of packed red blood cells over a 24-hour period) at Camp Bastion Role 3 Medical Facility, Afghanistan.
During the 12-month period, 59 personnel received massive transfusions. 51 (86%) personnel survived to be discharged from hospital in the UK. 48 (92%) personnel required ventilatory support for a median of 3 (2-8) days. The longest period of ventilation was 40 days; 29 (55%) personnel required vasopressor support and eight personnel (15%) required renal replacement therapy. The median total transfusion of blood components was 45 (28.5-62) units. There were seven transfusions of more than 100 units. Five of the personnel in this group (including the recipient of a 237-unit transfusion) survived to be discharged from University Hospitals Birmingham. On average, 1.21 (SD 0.28) units of packed red blood cells were transfused for every unit of fresh frozen plasma.
The use of the current MTP was associated with a high rate of survival. Survivors require a continuity of critical care with a median demand for 3 days. The early use of plasma and platelets can be successfully delivered in the battlefield despite operational and logistic constraints.
英国国防医疗服务部门制定了一项大量输血方案（MTP），该方案是重伤战斗伤员初始损伤控制复苏过程的一部分。本次对大量输血方案接受者的回顾性研究的主要目标是记录2009年在阿富汗作为大量输血方案一部分接受输血的伤员的存活率、所需重症监护支持水平以及所输注的血液成分。除了衡量我们目前的成效外，随着大量输血方案不断发展，这也应为未来的评估提供一个参考点。
这是一个由国防医学皇家中心和伯明翰大学医院重症监护科合作开展的项目。研究对象仅限于2009年受伤并在阿富汗巴斯蒂安营地3号医疗设施接受大量输血（定义为在24小时内输注10个或更多单位的浓缩红细胞）的英国军事人员。
在这12个月期间，59名人员接受了大量输血。51名（86%）人员存活并在英国出院。48名（92%）人员需要机械通气支持，中位时间为3（2 - 8）天。最长通气时间为40天；29名（55%）人员需要血管活性药物支持，8名（15%）人员需要肾脏替代治疗。血液成分的总输血量中位数为45（28.5 - 62）单位。有7次输血超过100单位。该组中有5名人员（包括接受237单位输血的患者）存活并从伯明翰大学医院出院。平均而言，每输注1单位新鲜冰冻血浆会输注1.21（标准差0.28）单位的浓缩红细胞。
当前大量输血方案的使用与高存活率相关。幸存者需要持续的重症监护，中位需求时间为3天。尽管存在作战和后勤方面的限制，但血浆和血小板的早期使用能够在战场上成功实现。
