Mayo Clinic Health System, 1400 Bellinger St., United States.
Mayo Clinic Health System, 1400 Bellinger St., United States.
Injury. 2022 Sep;53(9):2974-2978. doi: 10.1016/j.injury.2022.06.009. Epub 2022 Jun 21.
It is well established that achieving optimal ratios of packed red blood cells (PRBC) to fresh frozen plasma (FFP) to platelet ratios during massive transfusion leads to improved outcomes but is difficult to accomplish.
Between September 2018 and May 2019 our level 2 trauma center implemented 3 new processes to optimize transfusion ratios during massive transfusion protocol (MTP). Two units of low titer group O whole blood (LTOWB) were added as the first step to our MTP. Second, a dry erase board whiteboard was attached to each fluid warmer for real time recording of transfusions. Last, liquid plasma was incorporated into our MTP. We performed a retrospective review evaluating PRBC:FFP ratios for patients who had the massive transfusion protocol initiated and received 4 or more units of blood.
A total of 50 patients had the massive transfusion protocol initiated and received 4 or more units of PRBCs and/or LTOWB within 4 h of arrival. There were 21 patients evaluated prior to protocol changes and 29 patients after the changes. In the study group mean age, sex, pulse, systolic blood pressure (SBP), and injury severity scale (ISS) on admission were not different. In the pre-protocol (preP) group 90% of patients were blunt trauma and in the post-protocol group (postP) 72% were blunt trauma, p = 0. 22. For the preP group the mean units of PRBCs was 7.6 units and FFP 4.7 units. PostP the mean units of PRBCs was 11.4 units and FFP 10.0 units. PRBC/FFP ratios were 1.7 preP and 1.2 postP, p = 0.0072.
The institution of whole blood, use of the trauma white board, and the addition of liquid plasma to our transfusion services have allowed us to approach a 1:1 transfusion ratio during the course of our massive transfusions.
大量输血时，实现浓缩红细胞（PRBC）与新鲜冷冻血浆（FFP）与血小板比例的最佳比值可改善预后，但难以实现。
在 2018 年 9 月至 2019 年 5 月期间，我们的 2 级创伤中心实施了 3 项新流程，以优化大量输血方案（MTP）期间的输血比例。在 MTP 中，我们首先添加了 2 单位低滴度 O 型全血（LTOWB）。其次，在每个液体加温器上附加了一块可擦写白板，用于实时记录输血情况。最后，我们将液体血浆纳入 MTP。我们对接受大量输血方案并在 4 小时内接受 4 个或更多单位血液的患者进行了回顾性研究，评估了 PRBC：FFP 比值。
共有 50 例患者启动了大量输血方案，并在到达后 4 小时内接受了 4 个或更多单位的 PRBC 和/或 LTOWB。其中，有 21 例患者在方案更改前进行了评估，29 例患者在方案更改后进行了评估。在研究组中，患者的平均年龄、性别、脉搏、收缩压（SBP）和损伤严重程度评分（ISS）在入院时无差异。在方案前组（preP）中，90%的患者为钝性创伤，而在方案后组（postP）中，72%为钝性创伤，p=0.22。对于 preP 组，PRBC 的平均单位为 7.6 个单位，FFP 为 4.7 个单位。postP 组的 PRBC 平均单位为 11.4 个单位，FFP 为 10.0 个单位。PRBC/FFP 比值分别为 preP 组 1.7 和 postP 组 1.2，p=0.0072。
我们在输血服务中采用全血、使用创伤白板以及添加液体血浆，使我们在大量输血过程中能够接近 1:1 的输血比例。
