Dargère M, Langlais M-L, Gangloff C, Léostic C, Le Niger C, Ozier Y
Emergency department, centre hospitalier regional universitaire de Brest, 29200 Brest, France.
Urgent Medical Aid Service (SAMU), centre hospitalier regional universitaire de Brest, 29200 Brest, France.
Transfus Clin Biol. 2019 Nov;26(4):309-315. doi: 10.1016/j.tracli.2018.08.160. Epub 2018 Sep 12.
Haemorrhagic shock is a rare occurrence in emergency medicine but it can be associated with significant mortality. The purpose of this study was to evaluate the impact of a major haemorrhage protocol on patient management in Emergency Department Resuscitation Area.
A single-centre study was conducted to compare two periods, before and after institution of a massive haemorrhage protocol including the use of massive transfusion orders and the availability of packed red blood cell concentrates prior to patient's admission. Two groups of patients (in both trauma and non-trauma settings) were defined: "before protocol" and "after protocol". The primary outcome was the median transfusion time for a unit of red blood cell concentrate.
Forty patients were included: 22 for the "pre-protocol" group and 18 for the "post-protocol" group. The two groups were balanced with baseline characteristics. This study showed a significantly reduced median transfusion time for a unit of red blood cell concentrate from 20min pre-protocol to 9min post-protocol. The time between patient's admission and transfusion of the first red blood cell concentrate was reduced but non-significantly from 71min to 36min.
The major haemorrhage protocol optimised patient management by reducing the median transfusion time for red blood cell concentrates.
失血性休克在急诊医学中较为罕见，但可能导致显著的死亡率。本研究的目的是评估大出血方案对急诊科复苏区患者管理的影响。
进行了一项单中心研究，比较了实施大出血方案前后两个时期，该方案包括使用大量输血医嘱以及在患者入院前提供浓缩红细胞。定义了两组患者（包括创伤和非创伤情况）：“方案前”组和“方案后”组。主要结局是单位浓缩红细胞的中位输血时间。
纳入了40例患者：“方案前”组22例，“方案后”组18例。两组的基线特征均衡。本研究表明，单位浓缩红细胞的中位输血时间从方案前的20分钟显著缩短至方案后的9分钟。患者入院至首次输注浓缩红细胞的时间有所缩短，但未达到显著水平，从71分钟降至36分钟。
大出血方案通过缩短浓缩红细胞的中位输血时间优化了患者管理。
