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Massive transfusion protocols: current best practice

Authors Hsu Y, Haas T, Cushing M

Received 1 June 2015

Accepted for publication 5 September 2015

Published 10 March 2016 Volume 2016:4 Pages 15—27

DOI https://doi.org/10.2147/IJCTM.S61916

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Xiucheng Fan

Peer reviewer comments 3

Editor who approved publication: Prof. Dr. Cees Th. Smit Sibinga


Yen-Michael S Hsu,1 Thorsten Haas,2 Melissa M Cushing1

1Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY, USA; 2Department of Anesthesia, University Children's Hospital Zurich, Zurich, Switzerland

Abstract: Massive transfusion protocols (MTPs) are established to provide rapid blood replacement in a setting of severe hemorrhage. Early optimal blood transfusion is essential to sustain organ perfusion and oxygenation. There are many variables to consider when establishing an MTP, and studies have prospectively evaluated different scenarios and patient populations to establish the best practices to attain improved patient outcomes. The establishment and utilization of an optimal MTP is challenging given the ever-changing patient status during resuscitation efforts. Much of the MTP literature comes from the trauma population, due to the fact that massive hemorrhage is the leading cause of preventable trauma-related death. As we come to further understand the positive and negative clinical impacts of transfusion-related factors, massive transfusion practice can be further refined. This article will first discuss specific MTPs targeting different patient populations and current relevant international guidelines. Then, we will examine a wide selection of therapeutic products to support MTPs, including newly available products and the most suitable of the traditional products. Lastly, we will discuss the best design for an MTP, including ratio-based MTPs and MTPs based on the use of point-of-care coagulation diagnostic tools.

Keywords:
hemorrhage, MTP, antifibrinolytics, coagulopathy, trauma, ratio, logistics, guidelines, hemostatic

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