Implementation of a management protocol for massive bleeding reduces mortality in non-trauma patients: Results from a single centre audit

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• 作者：N. Martí ; nez-Calle^a ; F. Hidalgo^b ; A. Alfonso^a ; M. Muñ ; oz^c ; M. Herná ; ndez^a ; R. Lecumberri^a ; J.A. Pá ; ramo^a ; ^{japaramo@unav.es}
• 关键词：Massive bleeding protocol ; Non-trauma bleeding ; Transfusion ratio ; Hemostatics ; Mortality
• 刊名：Medicina Intensiva
• 出版年：2016
• 出版时间：December 2016
• 年：2016
• 卷：40
• 期：9
• 页码：550-559
• 全文大小：938 K
• 卷排序：40

文摘

To audit the impact upon mortality of a massive bleeding management protocol (MBP) implemented in our center since 2007.DesignA retrospective, single-center study was carried out. Patients transfused after MBP implementation (2007–2012, Group 2) were compared with a historical cohort (2005–2006, Group 1).BackgroundMassive bleeding is associated to high mortality rates. Available MBPs are designed for trauma patients, whereas specific recommendations in the medical/surgical settings are scarce.PatientsAfter excluding patients who died shortly (<6 h) after MBP activation (n = 20), a total of 304 were included in the data analysis (68% males, 87% surgical).InterventionsOur MBP featured goal-directed transfusion with early use of adjuvant hemostatic medications.Variables of interestPrimary endpoints were 24-h and 30-day mortality. Fresh frozen plasma-to-red blood cells (FFP:RBC) and platelet-to-RBC (PLT:RBC) transfusion ratios, time to first FFP unit and the proactive MBP triggering rate were secondary endpoints.ResultsAfter MBP implementation (Group 2; n = 222), RBC use remained stable, whereas FFP and hemostatic agents increased, when compared with Group 1 (n = 82). Increased FFP:RBC ratio (p = 0.053) and earlier administration of FFP (p = 0.001) were also observed, especially with proactive MBP triggering. Group 2 patients presented lower rates of 24-h (0.5% vs. 7.3%; p = 0.002) and 30-day mortality (15.9% vs. 30.2%; p = 0.018) – the greatest reduction corresponding to non-surgical patients. Logistic regression showed an independent protective effect of MBP implementation upon 30-day mortality (OR = 0.3; 95% CI 0.15–0.61).ConclusionsThese data suggest that the implementation of a goal-directed MBP for prompt and aggressive management of non-trauma, massive bleeding patients is associated to reduced 24-h and 30-day mortality rates.