Sage Journals: Discover world-class research

Abstract

Objective

The ‘Red Blanket’ protocol fast tracks trauma patients with severe blood loss to the designated trauma operating theatre directly from the hospital helipad or Emergency Department. This study aimed to assess the impact of patient blood management (PBM) strategies on severely injured trauma patients treated under the ‘Red Blanket’ protocol at a quaternary referral hospital.

Methods

This retrospective review was conducted on all urgent trauma cases that were treated under the ‘Red Blanket’ protocol in a ten-year period between January 2007 and December 2017. The use of blood products and patient outcomes was compared between the 3.5-year periods pre- and post-ROTEM^® implementation on 30th June 2014 (Jan 2011-June 2014 versus July 2014-Dec 2017).

Results

During the study period, 120 trauma patients were treated under the ‘Red Blanket’ protocol at our institution. Intention to treat analysis showed a reduction in fresh frozen plasma usage following the introduction of ROTEM^®-guided transfusion. Furthermore, subgroup analysis suggested reduced blood product usage in patients who survived.

Conclusions

Patient blood management is a coordinated package of systems and tools, including education, patient logistics, anaemia management, intraoperative cell salvage, rotational thromboelastometry and massive transfusion protocols that together conserve blood products and improve outcomes. The implementation of ROTEM^®-guided transfusion demonstrated a reduction in fresh frozen plasma usage.

Keywords

Blood transfusion haemorrhagic shock point-of-care testing thromboelastometry trauma centres

Get full access to this article

View all access options for this article.

References

Zacharowski

Spahn

. Patient blood management equals patient safety. Best Practice & Research Clinical Anaesthesiology 2016; 30: 159–169.

Perel

Prieto-Merino

Shakur

, et al. Predicting early death in patients with traumatic bleeding: development and validation of prognostic model. Br Med J 2012; 345: e5166.

Haas

Görlinger

Grassetto

, et al. Thromboelastometry for guiding bleeding management of the critically ill patient: a systematic review of the literature. Minerva Anestesiol 2014; 80: 1320–1335.

Tanaka

Bolliger

Vadlamudi

, et al. Rotational thromboelastometry (ROTEM)-based coagulation management in cardiac surgery and Major trauma. J Cardiothorac Vasc Anesth 2012; 26: 1083–1093.

Otsuka

Uehata

Sakoda

, et al. Impact of a streamlined trauma management approach and determinants of mortality among hemodynamically unstable patients with severe multiple injuries: a before-and-after retrospective cohort study. Trauma Surgery & Acute Care Open 2020; 5: e000534.

Dailey

. “Code red” protocol for resuscitation of the exsanguinated patient. The Journal of Emergency Medicine 1985; 2: 373–378.

Leahy

Roberts

Mukhtar

, et al. A pragmatic approach to embedding patient blood management in a tertiary hospital: PBM in a tertiary hospital. Transfusion 2014; 54: 1133–1145.

Haas

Goobie

Spielmann

, et al. Improvements in patient blood management for pediatric craniosynostosis surgery using a ROTEM ^® -assisted strategy - feasibility and costs. Pediatric Anesthesia 2014; 24: 774–780.

Leahy

Mukhtar

. From blood transfusion to patient blood management: a new paradigm for patient care and cost assessment of blood transfusion practice: blood shortage patient blood management. Intern Med J 2012; 42: 332–338.

10.

Theusinger

Madjdpour

Spahn

. Resuscitation and transfusion management in trauma patients: emerging concepts. Curr Opin Crit Care 2012; 18: 661–670.

11.

Wikkelsø

Wetterslev

Møller

, et al. Thromboelastography (TEG) or rotational thromboelastometry (ROTEM) to monitor haemostatic treatment in bleeding patients: a systematic review with meta-analysis and trial sequential analysis. Anaesthesia 2017; 72: 519–531.

12.

Veigas

Callum

Rizoli

, et al. A systematic review on the rotational thrombelastometry (ROTEM®) values for the diagnosis of coagulopathy, prediction and guidance of blood transfusion and prediction of mortality in trauma patients. Scand J Trauma Resusc Emerg Med 2016; 24: 114.

13.

Stensballe

Henriksen

Johansson

. Early haemorrhage control and management of trauma-induced coagulopathy: the importance of goal-directed therapy. Curr Opin Crit Care 2017; 23: 503–510.

14.

Thomas

Wee

Clyburn

, et al. Blood transfusion and the anaesthetist: management of massive haemorrhage: blood transfusion and the anaesthetist: management of massive haemorrhage. Anaesthesia 2010; 65: 1153–1161.

15.

Moore

Liras

, et al. Targeting resuscitation to normalization of coagulating status: hyper and hypocoagulability after severe injury are both associated with increased mortality. Am J Surg 2017; 214: 1041–1045.

16.

Unruh

Reyes

Helmer

, et al. An evaluation of blood product utilization rates with massive transfusion protocol: before and after thromboelastography (TEG) use in trauma. Am J Surg 2019; 218: 1175–1180.

17.

Campbell

Wake

Walters

, et al. Implementation of point-of-care ROTEM® into a trauma major haemorrhage protocol: a before and after study. Emerg Med Australas 2021; 33: 457–464.

18.

Balogh

Way

Bendinelli

, et al. Current concepts on haemorrhage control in severe trauma. Aust N Z J Surg 2020; 90: 406–408.

19.

Carless

Henry

Moxey

, et al. Cell salvage for minimising perioperative allogeneic blood transfusion. In: Cochrane

(ed) Cochrane database syst rev. Chichester, UK: John Wiley & Sons, Ltd, 2010, pp.CD001888.pub3.

20.

Roets

. A retrospective study at the Royal Brisbane and Women's Hospital (RBWH) in Brisbane, Queensland (case study): guidance for the provision of intraoperative cell salvage. National Blood Authority, Australia 2014; Appendix 1 (Business case): 13.

21.

Rahouma

Kamel

Jodeh

, et al. Does a balanced transfusion ratio of plasma to packed red blood cells improve outcomes in both trauma and surgical patients? A meta-analysis of randomized controlled trials and observational studies. Am J Surg 2018; 216: 342–350.