Massive Transfusion Protocol

• Definition
  • Replacement of 100% of BV within 6 hours
  • Administration of 50% of BV within 1 hour
• Complications
  • Hypothermia
  • Acidosis
  • Hypocalcaemia - Citrate binds ionized calcium
    • Impact - impaired myocardial relaxation
• MTP
  • System set up at each hospital with goal of improving survival for bleeding pts
  • Blood products are administered in a 1:1:1 ratio (RBC/Platelets/FFP)
  • Indications for MTP activation
    • Replacement of 50% BV within 1 hour
    • Replacement of 100% BV within 24 hrs
    • Haemorrhagic shock with active bleeding
    • Use of 4 units of RBC within 4 hours
    • Discretion of treating physician
    • Majorly injured patient with high likelihood of transfusion required
  • ABC score predicts need for MTP in trauma (also activaiton criteria for Code Crismson)
    • 2/4 = Likely need MTP
      • Penetrating mechanism
      • BP < 90
      • HR > 120
      • • FAST
  • End points for transfusion
    • Active surgical bleeding has been controlled
    • No further need for red cells
    • Temp > 35
    • pH > 7.3
    • Fibrinogen > 1.5
    • INR < 1.5/ PT < 16/ aPTT < 42
    • Hb > 80
  • Bloods done before starting and every 6 units
    • FBC
    • U+E with calcium
    • Coags
    • ?TEG/ROTEM if possible