Department of Surgery, Alrijne Medical Centre, 2353 GA Leiderdorp, the Netherlands; Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, 3000 CA Rotterdam, the Netherlands.
Military Blood Bank, Ministry of Defence, 3584 EZ Utrecht, the Netherlands.
Injury. 2022 Jan;53(1):49-53. doi: 10.1016/j.injury.2021.10.034. Epub 2021 Oct 31.
Transfusion strategy for trauma patients with massive haemorrhage is often incorporated in massive transfusion protocols (MTP). Albeit correct MTP use results in better patient outcome, research regarding the state of MTP knowledge is scarce. The objective of this study is therefore to assess knowledge of local MTP and massive transfusion strategy in the level 1 trauma centres in the Netherlands. Our hypothesis is that actual MTP knowledge is low and transfusion strategy differs.
Surveys were sent out in January 2020 to all trauma and vascular surgeons, anaesthesiologists, emergency department physicians of the largest level 1 trauma centre (locally, n = 113) and to one trauma surgeon, emergency physician and anaesthesiologist in each of the nine other governmentally assigned level 1 trauma centres in the Netherlands (nationally, n = 27). The respondents were subdivided into a frequent user group (MTP usage ≥ 4 times in 2019) and a non-frequent user group (MTP usage < 4 in 2019). Data are expressed as numbers and percentages.
Response rate was (n = 48; 42%) for the local survey and (n = 14; 52%) for the national survey. Locally, (n = 23; 48%) and (n = 25; 52%) respondents were defined frequent and non-frequent users respectively and national respondents all as frequent users. In total, (n = 13; 27%) of local respondents were aware of the current local composition of the MTP. Respondents indicated to transfuse erythrocytes first, followed by plasma and platelets (local non-frequent users n = 23; 92%, local frequent users n = 21; 91% and national frequent users n = 13; 93%). The indication for platelet transfusion was units erythrocytes transfused (local non-frequent users n = 10; 40% frequent users locally n = 11; 48% and nationally n = 5; 36%) and clinical view (local non-frequent users n = 9; 36%, frequent users locally n = 8; 35% and n<5 nationally. Whereas few respondents claimed (n = 5; 21% non-frequent users locally and n <5 nationally) to transfuse platelets based on platelet counts. Viscoelastic haemostatic assays were performed during MTP, but only by frequent users.
The majority of physicians dealing with massive transfusion in trauma patients were not aware of the exact composition of the MTP and consensus regarding transfusion strategy and indication for platelet transfusion was low.
创伤患者大出血的输血策略通常包含在大量输血方案（MTP）中。尽管正确使用 MTP 可改善患者预后，但有关 MTP 知识现状的研究却很少。因此，本研究旨在评估荷兰一级创伤中心对当地 MTP 和大量输血策略的了解。我们的假设是，实际的 MTP 知识水平较低，并且输血策略存在差异。
2020 年 1 月，我们向最大的一级创伤中心的所有创伤和血管外科医生、麻醉师、急诊医师（本地，n=113）以及荷兰其他 9 个政府指定的一级创伤中心的一名创伤外科医生、急诊医师和麻醉师（全国，n=27）发送了调查。受访者被分为频繁使用者组（2019 年使用 MTP 治疗≥4 次）和非频繁使用者组（2019 年使用 MTP 治疗<4 次）。数据以数字和百分比表示。
本地调查的回复率为 48%（n=48），全国调查的回复率为 52%（n=14）。本地调查中，分别有 23 名（48%）和 25 名（52%）受访者被定义为频繁使用者和非频繁使用者，而全国调查的所有受访者均被定义为频繁使用者。在本地，总共有 13 名（27%）受访者了解当前 MTP 的组成情况。受访者表示先输注红细胞，然后输注血浆和血小板（本地非频繁使用者 n=23；92%，本地频繁使用者 n=21；91%和全国频繁使用者 n=13；93%）。血小板输注的指征是输注的红细胞单位（本地非频繁使用者 n=10；40%，本地频繁使用者 n=11；48%和全国 n=5；36%）和临床观察（本地非频繁使用者 n=9；36%，本地频繁使用者 n=8；35%和全国 n<5）。然而，只有少数受访者（本地非频繁使用者 n=5；21%，全国 n<5）表示根据血小板计数输注血小板。在 MTP 期间进行了粘弹性止血检测，但仅由频繁使用者进行。
处理创伤患者大量输血的大多数医生并不了解 MTP 的具体组成，并且在输血策略和血小板输注指征方面也没有达成共识。
