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Major Haemorrhage Policy for Trauma

Major Haemorrhage Policy for Trauma. Rachel Hawes RVI Northern trauma network conference March 2014. Background. Leading cause of traumatic death Advances in haemostatic resuscitation Balanced transfusion 1:1:1:1 Introduction of MHP Questions How many major haemorrhage pt?

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Major Haemorrhage Policy for Trauma

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  1. Major Haemorrhage Policy for Trauma Rachel Hawes RVI Northern trauma network conference March 2014

  2. Background • Leading cause of traumatic death • Advances in haemostatic resuscitation • Balanced transfusion 1:1:1:1 • Introduction of MHP • Questions • How many major haemorrhage pt? • Frequency of Acute Coagulopathy of Trauma (ACoT) • How effective is our MHP?

  3. RVI Major Haemorrhage Policy • Standardise blood product use • Reduce logistical delay • Prehospital initiation • Pre-thawed FFP • avoid delay in receiving balanced transfusion

  4. Audit • Inclusions • All trauma patients to RVI • April 2012 - April 2013 • >18 yrs • Activation of MHP • Or >4 products in 1 hr • Exclusions • Children • Preceding medical event • Transfers via Trauma Units • Data Collection • Injury Severity Score (ISS) • TARN Predicted Survival • Actual 30 day mortality • Presentation - Hb, PT, Fib • Products Transfused • Post MHP - Hb, PT, Fib

  5. Results - How much trauma do we get? • April 2012 - April 2013 • 935 trauma calls • 899 TARN patients • RTA • Assault • Fall • Frequent of major haemorrhage? • 51 MHP Patients (5.6%)

  6. Injury Severity Score v Mortality

  7. Mortality - Standard Trauma Pt v MHP Pt

  8. ISS versus Predicted & Actual Outcome

  9. Coagulopathy

  10. ACoT on Presentation in ED? Fibrinogen on presentation Fibrinogen <1.5 = 21% PT on presentation PT> 18 = 16%

  11. Is ACoT due to Prehospital Fluid? • No correlation between fluid volumes given and • Hb on presentation • PT on presentation • Fib on presentation

  12. Presence of Coagulopathy Post MHP • Post MHP Fib <1.5 = 0% • (Data for 33 Pt) • Post MHP PT > 18 = 3% • (Data for 29 Pt)

  13. Hb on Arrival v Post MHP • Hb on arrival <8.0 = 6.8% • Over and under transfusion • Hb post MTP <8.0 = 5.8%

  14. The Future • Over and under transfusion • Deviation from policy • Timing of lab results • Lack of Point of Care testing - guide treatment • Potential role of ROTEM/ TEG • Prehospital Transfusion

  15. Limitations • Early deaths after presentation • Unable to get bloods • Included in ISS calculations but excluded for comparison of lab data

  16. Summary • Trauma - Mortality proportional to ISS • 5% of patients have major haemorrhage • Increased mortality ass with major haemorrhage • 20% established ACoT on arrival • Not related to prehospital fluid administration • MHP effective in treatment and prevention of ACoT • Future • POCT – TEG or ROTEM • ‘Blood on Board’ HEMS

  17. Questions?

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