Massive haemorrhage protocol: what's the best protocol?

Abstract

Massive transfusion protocols became common practice between 2006 and 2010. The terminology of ‘massive transfusion protocol’ was improved to ‘massive haemorrhage protocol ( MHP )’ with the astute recognition that at the start of such a protocol, it is unclear which patients will meet the definition of massive transfusion (10 U/24 h). Despite the majority of the literature being reported from the trauma population, hospitals have generally adopted a single MHP for all patients. It remains unclear whether the same protocol can be used for all patients. MHP s assist with the prevention and management of the acute coagulopathy of trauma/shock ( ACOTS ). The goals of a MHP are to improve haemostasis, communication and patient outcomes. The protocol must be specific for an individual hospital, depending on factors such as prehospital transport times, distance from laboratory to trauma and operating rooms, patient populations served and types of tests available. The key components of a MHP are the 6Ts: t riggering of the protocol, laboratory t esting, t ranexamic acid, t emperature maintenance, t ransfusion support and t ermination of the protocol when haemostasis is achieved. The evidence and importance of each of these steps will be discussed in detail. It is also critical that a quality assurance programme supports the MHP . Poor compliance with the institutional MHP is associated with inferior survival. Each MHP activation should be followed by a formal debrief by the team. Audits should be performed to determine compliance and to inform annual update of the MHP . Formal training and/or simulation should be a core part of the policy.