General Surgery and Trauma
The purpose of this article is to review hospital-wide massive transfusion protocol administration to localize a standardized definition for massive transfusion and massive transfusion protocol (MTP). This article is meant to provide succinct knowledge for hemorrhagic resuscitation for all inpatient hospital providers.
A literature review through Google Scholar was conducted to examine current massive transfusion protocols for rapid resuscitation with non-trauma and trauma etiology. No data analysis was run to assess statistical significance. Exclusion criteria were articles published prior to 2018, with exception to one article, and articles specific to obstetrics, orthopedic, or pediatric specialties. Inclusion criteria included journals that allowed full access downloads with the University of Lynchburg library access.
After a thorough literature review, findings conclude that there were no significant changes in reduction of mortality with manipulations of the ratios for platelets, red blood cells, and plasma. The literature for MTP protocol suggests a 1:1:1 ratio of packed red blood cells, fresh-frozen plasma, and platelets at a minimum for MTP. Supplemental agents like tranexamic acid (TXA), calcium, and cryoprecipitate are imperative with large volume resuscitation.
Although there are recommended protocols for MTP, the literature remains ambiguous. Further needs to be done for defining what criteria prompts a MTP activation. Newer technology is available for pinpointing which product is correct for resuscitation through standard thrombelastography but less accessible in rural areas. A higher index of clinical suspicion needs to be present amongst all hospital providers.
Dhaliwal SK. Massive transfusion protocol. Lynchburg Journal of Medical Science. 2023; 5(1).
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