SUMMARY of MASSIVE TRANSFUSION PROTOCOL (MTP) for HEMORRHAGIC SHOCK - ASA COMMITTEE on BLOOD MANAGEMENT



Massive hemorrhage and resuscitation can result in refractory coagulopathy if not aggressively treated. The use of MTPs facilitate rapid availability of components in an increased ratio of plasma and platelets to RBCs. Increased ratios of plasma and platelets to RBCs and their timely administration are thought to improved outcome in trauma, decrease coagulopathy and transfusion requirements based on retrospective data. Large volumes of plasma are required to correct coagulopathy, so early administration is presumably more efficacious. The approach would be different when specific factor concentrates are used. Point of care viscoelastic assays may allow for goal directed therapy in coagulopathy of trauma and massive transfusion including the use of antifibrinolytics when appropriate (although localized fibrinolysis may not be seen on TEG/ROTEM). Single agent therapy such as rFVIIa may have a role in coagulopathic trauma patients but safety is still a concern. A restrictive transfusion strategy should be adopted once hemorrhage is controlled to minimize unnecessary exposure to blood.

MTP practice is still fraught with many unresolved issues such as use of fibrinogen and/or prothrombin complex concentrate and blunt vs penetrating trauma. Understanding the mechanism of hemorrhage is not universal and is different in the obstetrical population as it is in pediatric or cardiovascular patients. This may add to the limitation of universal adoption of a single ratio driven MTP. Well designed, prospective randomized trials are required to determine optimal transfusion ratios and timing of blood component administration.


Link: http://www.asahq.org/For-Members/~/media/For%20Members/About%20ASA/ASA%20Committees/MTP%20for%20ASA%20Transfusion%20Committee%20Final.ashx