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THE IMPLEMENTATION OF MASSIVE HAEMORRHAGE PROTOCOL (MHP) FOR THE MANAGEMENT OF MAJOR TRAUMA:A TEN YEAR,SINGLE CENTRE STUDY OF PATIENT OUTCOMES
  1. R Mothukuri,
  2. C Battle,
  3. K Guy,
  4. G Mills,
  5. PA Evans
  1. Emergency Department, Morriston Hospital, Swansea, UK

    Abstract

    Objectives & Background Massive haemorrhage in major trauma is one of the leading causes of death. Haemostatic failure leads to uncontrolled blood loss and reduced tissue perfusion resulting in coagulopathy. Recent studies support the use of early component replacement. In the UK, trauma centres have adopted the use fresh frozen plasma, platelets and packed red cells in the ratio of 1:1:1 to improve and maintain normal haemostatic function. In 2011, MHP was introduced to improve links between the trauma team and transfusion team and accelerate the issue of blood products.Our aim is to evaluate and compare the outcomes before and after implementation of MHP.

    Methods All trauma patients admitted to the Emergency Department (ED) of a large teaching hospital in South Wales between 2005 and 2015 were studied, using the data collated for submission to the Trauma Audit and Research Network (TARN). Demographic variables included sex, age, Injury Severity score (ISS) code, PS14 and injury mechanism; management variables included whether the trauma team was activated, whether Tranexamic acid (TXA) was given and whether the MHP was instigated. Outcome variables included hospital and critical care length of stay and mortality. Patients were divided into two groups; those admitted before the introduction of MHP(pre-MHP) and those admitted after its introduction (post-MHP). Differences in the data were analysed using the Fisher Exact test (categorical variables) and student's t-test (continuous variables).

    Results A total of 832 patients were included in the analysis,446 in the pre-MHP and 386 in the post-MHP group.There were no significant differences in patient age, sex, PS14 or injury mechanism. The pre-MHP group had a significantly higher ISS (p=0.02). There was no difference in the activation of the trauma team between the two groups. There was no difference in the mortality between the two groups. Tranexamic acid and the MHP were used in a significantly greater number of cases in the post-MHP group. Hospital length of stay and the critical care length of stay were significantly reduced following the introduction of the MHP (both p<0.001).

    Conclusion We demonstrate,a well-defined MHP and the use of TXA contributed to reducing patient length of stay both in critical care and in hospital.Further data analysis is needed to show correlation between use of component replacement and improved outcome.

    • emergency departments

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