Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
Department of Pathology, University of Pittsburgh and the Institute for Transfusion Medicine, Pittsburgh, Pennsylvania.
Transfusion. 2019 May;59(5):1637-1643. doi: 10.1111/trf.15149. Epub 2019 Feb 5.
Massive transfusion protocols (MTPs) provide blood products rapidly and in fixed amounts. MTPs are commonly used in trauma but may also be used in other clinical settings, although evidence to support fixed-ratio resuscitation in nontraumatic hemorrhage is lacking. The goals of this study were to describe the types and contents of available MTPs and the clinical indications for MTP activation.
A survey was distributed to 353 transfusion medicine specialists to assess the types and contents of available MTPs. Survey participants were invited to provide the clinical indications for consecutive adult and pediatric MTP activations for at least 6 months during 2015 to 2017.
There were 125 completed surveys (35% response rate) including three from children's specialty hospitals. Most hospitals that treated adult patients (90/122, 74%) utilized only one MTP for all adult bleeding emergencies, while one hospital had no MTP. Of the 31 hospitals that provided more than one adult MTP, 20 provided MTPs specific for obstetric bleeding cases. Of these, 50% (10/20) included at least one pool of cryoprecipitate or fibrinogen concentrate in the first MTP round, compared with 14% (13/90) of the hospitals with one MTP (p = 0.0012). Fifty-seven hospitals provided the clinical indication for 4176 adult and 155 pediatric MTP activations. Although trauma was the single most common indication, the majority of adult (58%) and pediatric (65%) activations were for nontrauma indications.
The majority of hospitals use a single MTP to manage massive hemorrhage. The majority of MTP activations were for nontrauma indications.
大量输血方案（MTP）可快速且按固定剂量提供血液制品。MTP 常用于创伤，但也可用于其他临床情况，尽管缺乏非创伤性出血固定比例复苏的证据。本研究的目的是描述现有的 MTP 类型和内容，以及 MTP 激活的临床指征。
向 353 名输血医学专家分发了一份调查，以评估现有的 MTP 类型和内容。调查参与者被邀请提供 2015 年至 2017 年期间至少 6 个月连续成人和儿科 MTP 激活的临床指征。
共有 125 份完整的调查回复（35%的回复率），其中包括来自儿童专科医院的 3 份。大多数治疗成人患者的医院（90/122，74%）对所有成人出血紧急情况仅使用一种 MTP，而一家医院没有 MTP。在提供超过一种成人 MTP 的 31 家医院中，有 20 家医院提供了专门用于产科出血病例的 MTP，其中 50%（10/20）在第一轮 MTP 中至少包含一份冷沉淀或纤维蛋白原浓缩物，而 90 家医院中的一家（90/122，74%）仅使用一种 MTP（p=0.0012）。57 家医院提供了 4176 例成人和 155 例儿科 MTP 激活的临床指征。尽管创伤是单一最常见的指征，但大多数成人（58%）和儿科（65%）激活是非创伤性指征。
大多数医院使用单一 MTP 来治疗大出血。大多数 MTP 激活是非创伤性指征。
