Baumann Kreuziger L M, Morton C T, Subramanian A T, Anderson C P, Dries D J
Department of Hematology, Oncology and Transplant, University of Minnesota, Minneapolis, Minnesota, USA.
Transfus Med. 2014 Jun;24(3):162-8. doi: 10.1111/tme.12096. Epub 2013 Dec 26.
To review outcomes of massive transfusion protocol (MTP) activation and determine the impact of MTP implementation on blood bank use.
MTP has been established to rapidly provide plasma and packed red blood cells in ratios approaching 1 : 1. Due to availability, MTP has been utilised in non-traumatic haemorrhage despite evidence of benefit in this population. Our hospital-wide implementation of MTP was reviewed for propriety, outcomes and effect on blood bank resources.
Retrospective cohort study of patients receiving transfusion after MTP activation from October 2009 to 2011. Underlying medical conditions and baseline medication use were determined. In-hospital and 24-h mortality were compared with evaluation for confounding by Acute Physiology And Chronic Health Evaluation (APACHE) score and duration of MTP activation. Blood product use before and after MTP implementation was reviewed.
MTP activation occurred in 62 trauma and 63 non-trauma patients. Non-trauma patients were older, had more underlying medical conditions and higher APACHE scores compared with trauma patients; 24-h mortality was higher in trauma compared with non-trauma patients (27·4 vs 11·1%, P = 0·02). There was no significant difference of in-hospital mortality. Transfusion ratio did not differ between trauma and non-trauma patients and was not associated with mortality even when MTP activation duration and APACHE score were considered. Hospital-wide blood product use did not change with MTP implementation.
MTP may be successfully used in trauma and non-trauma settings without significantly impacting overall blood product utilisation. Inclusion of non-trauma patients into prospective studies of resuscitation with blood products is warranted to ensure benefit in these patients.
回顾大量输血方案（MTP）启动的结果，并确定MTP实施对血库使用的影响。
已制定MTP以快速按接近1∶1的比例提供血浆和红细胞悬液。由于其可用性，尽管在非创伤性出血人群中获益的证据不足，但MTP仍被用于非创伤性出血。我们对全院范围内MTP的实施情况进行了合理性、结果及对血库资源影响方面的审查。
对2009年10月至2011年MTP启动后接受输血的患者进行回顾性队列研究。确定基础疾病和基线用药情况。通过急性生理与慢性健康状况评分（APACHE）和MTP启动持续时间评估混杂因素，比较住院期间及24小时死亡率。回顾MTP实施前后血液制品的使用情况。
62例创伤患者和63例非创伤患者启动了MTP。与创伤患者相比，非创伤患者年龄更大，基础疾病更多，APACHE评分更高；创伤患者的24小时死亡率高于非创伤患者（27.4%对11.1%，P = 0.02）。住院死亡率无显著差异。创伤患者和非创伤患者的输血比例无差异，即使考虑MTP启动持续时间和APACHE评分，输血比例也与死亡率无关。全院血液制品的使用并未因MTP的实施而改变。
MTP可成功用于创伤和非创伤情况，而不会显著影响总体血液制品的使用。有必要将非创伤患者纳入血液制品复苏的前瞻性研究，以确保这些患者能从中获益。
