Massive transfusion protocols in the Netherlands. Consensus or confusion?

Injury, vol. 53, pp. 49–53

Abstract

INTRODUCTION: Transfusion strategy for trauma patients with massive haemorrhage is often incorporated in massive transfusion protocols (MTP). Albeit correct MTP use results in better patient outcome, research regarding the state of MTP knowledge is scarce. The objective of this study is therefore to assess knowledge of local MTP and massive transfusion strategy in the level 1 trauma centres in the Netherlands. Our hypothesis is that actual MTP knowledge is low and transfusion strategy differs. MATERIALS AND METHODS: Surveys were sent out in January 2020 to all trauma and vascular surgeons, anaesthesiologists, emergency department physicians of the largest level 1 trauma centre (locally, n = 113) and to one trauma surgeon, emergency physician and anaesthesiologist in each of the nine other governmentally assigned level 1 trauma centres in the Netherlands (nationally, n = 27). The respondents were subdivided into a frequent user group (MTP usage ≥ 4 times in 2019) and a non-frequent user group (MTP usage < 4 in 2019). Data are expressed as numbers and percentages. RESULTS: Response rate was (n = 48; 42%) for the local survey and (n = 14; 52%) for the national survey. Locally, (n = 23; 48%) and (n = 25; 52%) respondents were defined frequent and non-frequent users respectively and national respondents all as frequent users. In total, (n = 13; 27%) of local respondents were aware of the current local composition of the MTP. Respondents indicated to transfuse erythrocytes first, followed by plasma and platelets (local non-frequent users n = 23; 92%, local frequent users n = 21; 91% and national frequent users n = 13; 93%). The indication for platelet transfusion was units erythrocytes transfused (local non-frequent users n = 10; 40% frequent users locally n = 11; 48% and nationally n = 5; 36%) and clinical view (local non-frequent users n = 9; 36%, frequent users locally n = 8; 35% and n<5 nationally. Whereas few respondents claimed (n = 5; 21% non-frequent users locally and n <5 nationally) to transfuse platelets based on platelet counts. Viscoelastic haemostatic assays were performed during MTP, but only by frequent users. CONCLUSION: The majority of physicians dealing with massive transfusion in trauma patients were not aware of the exact composition of the MTP and consensus regarding transfusion strategy and indication for platelet transfusion was low.

Authors 6

1. Tim W.H. Rijnhout corresponding Aachen Department of Surgery, Alrijne Medical Center

   Erasmus MC · Alrijne Ziekenhuis · Erasmus University Rotterdam

   Affiliation as printed

   Department of Surgery, Alrijne Medical Centre, 2353 GA Leiderdorp, the Netherlands; Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, 3000 CA Rotterdam, the Netherlands. Electronic address: twhrijnhout@alrijne.nl

   Department of Surgery, Alrijne Medical Centre, 2353 GA Leiderdorp, the Netherlands

   Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, 3000 CA Rotterdam, the Netherlands

2. Femke Noorman corresponding

   Ministry of Defence

   Affiliation as printed

   Military Blood Bank, Ministry of Defence, 3584 EZ Utrecht, the Netherlands. Electronic address: f.noorman@mindef.nl

   Military Blood Bank, Ministry of Defence, 3584 EZ Utrecht, the Netherlands

3. Oscar J.F. Van Waes corresponding

   Erasmus MC

   Affiliation as printed

   Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, 3000 CA Rotterdam, the Netherlands. Electronic address: o.vanwaes@erasmusmc.nl

   Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, 3000 CA Rotterdam, the Netherlands

4. Michaëla van Bohemen corresponding

   Erasmus MC

   Affiliation as printed

   Department of Haematology, Erasmus MC, University Medical Centre Rotterdam, CE 3015 Rotterdam, the Netherlands. Electronic address: m.vanbohemen@erasmusmc.nl

   Department of Haematology, Erasmus MC, University Medical Centre Rotterdam, CE 3015 Rotterdam, the Netherlands

5. M.H.J. Verhofstad corresponding

   Erasmus MC

   Affiliation as printed

   Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, 3000 CA Rotterdam, the Netherlands. Electronic address: m.verhofstad@erasmusmc.nl

   Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, 3000 CA Rotterdam, the Netherlands

6. Rigo Hoencamp corresponding Aachen Department of Surgery, Alrijne Medical Center Department of Surgery, Leiden University Medical Centre

   Leiden University · Leiden University Medical Center · Erasmus MC · Ministry of Defence · Alrijne Ziekenhuis · Erasmus University Rotterdam

   Affiliation as printed

   Department of Surgery, Alrijne Medical Centre, 2353 GA Leiderdorp, the Netherlands; Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, 3000 CA Rotterdam, the Netherlands; Defence Healthcare Organization, Ministry of Defence, 3584 AB Utrecht, the Netherlands; Department of Surgery, Leiden University Medical Centre, 2333 ZA Leiden, the Netherlands. Electronic address: r.hoencamp@erasmusmc.nl

   Defence Healthcare Organization, Ministry of Defence, 3584 AB Utrecht, the Netherlands

   Department of Surgery, Alrijne Medical Centre, 2353 GA Leiderdorp, the Netherlands

   Department of Surgery, Leiden University Medical Centre, 2333 ZA Leiden, the Netherlands

   Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, 3000 CA Rotterdam, the Netherlands