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Dr. Gayathri.A.M , Dr.S.Sathyabhama , Dr.Debasish Gupta

Dr. Gayathri.A.M , Dr.S.Sathyabhama , Dr.Debasish Gupta Department of Transfusion Medicine, SCTIMST,Trivandrum. RETROSPECTIVE ANALYSIS OF MASSIVE TRANSFUSION PRACTICE IN NON-TRAUMA RELATED HEMORRHAGIC SHOCK IN A TERTIARY CARE CENTRE. MASSIVE TRANSFUSION.

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Dr. Gayathri.A.M , Dr.S.Sathyabhama , Dr.Debasish Gupta

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  1. Dr. Gayathri.A.M, Dr.S.Sathyabhama, Dr.Debasish Gupta Department of Transfusion Medicine, SCTIMST,Trivandrum RETROSPECTIVE ANALYSIS OF MASSIVE TRANSFUSION PRACTICE IN NON-TRAUMA RELATED HEMORRHAGIC SHOCK IN A TERTIARY CARE CENTRE

  2. MASSIVE TRANSFUSION

  3. MAXIMUM SURGICAL BLOOD ORDER SCHEDULE (MSBOS) DESIGNED FOR OUR INSTITUTE NEUROSURGERY CASES CARDIOTHORACIC CASES

  4. MASSIVE TRANSFUSION PROTOCOL OF OUR INSTITUTE >40 Kg BODY WEIGHT < 5 Kg BODY WEIGHT 5- 15 Kg BODY WEIGHT 15-40 Kg BODY WEIGHT

  5. AIMS & OBJECTIVES MATERIALS AND METHODS • To analyse retrospectively the massive transfusion practices and resultant outcome of patients over a period of two years • This is a retrospective observational study of all patients who received a massive transfusion for non-traumatic hemorrhagic shock over a two-year period (2016-2017) • The primary outcome was in-patient hospital survival • Electronic medical records of 53 non-traumatic patients including both adult and paediatric cases that were admitted and had massive transfusion were assessed

  6. Variables include : • Age • Sex • Body weight • Co-morbidities • Drug history • Diagnosis and nature of surgical procedure • Pre-surgical laboratory investigations (Hb, PCV, platelet counts, PT/INR, aPTT, potassium, BUN) & post surgical laboratory parameters • Ratio of blood components transfused • Period of ICU, Ventilator, Extra-corporeal membrane oxygenator and hospital stay • Recovery index

  7. RESULTS 2800 TOTAL CASES SINCE 2 YEARS 1450 TOTAL CASES: 6750 0.78% GENDERSCORE

  8. DIAGNOSIS PROCEDURE

  9. PRE- SURGICAL DRUG INTAKE ASSOCIATED CO-MORBIDITIES

  10. DURATION OF HOSPITAL STAY, ICU STAY & VENTILLATOR STAY DISTRIBUTION OF WEIGHT IN ALL CASES NO. OF PATIENTS

  11. INTRA & POST OPERATIVE BLOOD USAGE ADULT PAEDIATRIC

  12. PRE & POST SURGICAL INVESTIGATIONCOMPARISON p value 15.9 3.83 2.01 1.6 26.13 2.28 31.07 38.32 10.6 13.1

  13. OUTCOME FOLLOWING MASSIVE TRANSFUSION

  14. CARDIOTHORACIC SURGERY (n=12) Post op cardiac tamponade (3 cases) NEUROSURGERY (n=2) MORTALITY ANALYSIS On table: Acute uncontrolled bleed in ruptured TAAA (2 cases) CKD on Dialysis (1 case) Ruptured multiple Intra cranial Aneurysm Poor preoperative anticoagulation management and multiple comorbidities (6 cases)

  15. OBSERVATIONS • All paediatric cases survived after appropriate massive transfusion protocol • Potassium and BUN in all scenarios • Hb, PCV, Platelet counts, PT & APTT in expired cases Statistically insignificant

  16. CONCLUSION • A good massive transfusion protocol is required to increase the patient survival rates • Good orchestration between clinicians, anaesthesiologist and blood center team • Appropriate utilisation of blood units • Turn around time should be reduced

  17. LIMITATIONS • TEG reporting were insufficient to do analysis • Baseline D-Dimer investigation not performed

  18. REFERENCES • Kevin M S, Kimberly A D, Felix Y L et al. The status of massive transfusion protocols in United States trauma centers: massive transfusion or massive confusion? Transfusion 2010;50:1545-51.258 • Norgaard A, Stensballe J, de Lichtenberg T H,et al. Three-year follow-up of implementation of evidence-based transfusion practice in a tertiary hospital. Vox Sang. 2017;112:229-397 1 • Shahram P, Hosseinali K, Golnar S, et al.Comparison of the impact of applications of Targeted Transfusion Protocol and Massive Transfusion Protocol in trauma patients. Korean J Anesthesiol 2017; 70: 626-32 • Keyvan K, Rachel O, Terrence M Y, et al. Prediction of massive blood transfusion in cardiac surgery. CAN J ANESTH 2006 ;53:781–94 • Zoe K M, Gemma C, Susan B, et al. Optimal Dose, Timing and Ratio of Blood Products in Massive Transfusion: Results from a Systematic Review. Transfus Med Rev. 2018;32(1):6-15

  19. THANKYOU

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