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Mon Jul 23 00:16:07 BST 2007

Hi Karim,
The hospital protocol is actually lagging behing the labs own practice and they are supporting the new practices of the theatre teams:

A:
1- After fourth unit of blood we start requesting 1:1 FFP:Blood

B
After 6 unit transfusion we now assume that you are already working on an established coagulopathy, especially if they are hypothermic

After 6 units, request 2 FFP if  we are employing permissive anaemia (target 7-8 g/dl). If higher Hb level and haemostasis has been clinically achieved then may give none at this late stage.

NO Factor VIIa if they have a temp less than 35 degree becasue of its dramatcally reduced function.

C
Lab clotting result will realistically take about 30 mins to 1 hour, which is obviously useless if still bleeding or operating.

We have no reliable NPT and we do not currently have a TEG as our transfusion team believe that it is not a reliable measure

Cheers
Mark F
UK

----- Original Message ----
From: Karim Brohi <karim at trauma.org>
To: Trauma & Critical Care mailing list <trauma-list at trauma.org>
Sent: Sunday, 22 July, 2007 10:37:24 PM
Subject: Massive Transfusion Protocol: What's in YOUR pack?

Dear All,

A straw poll if you don't mind on massive transfusion protocols for
traumatic haemorrhage.  Please base your answers on your current practice or
your institution's current practice, not latest research / hearsay etc:

A. If you HAVE a massive transfusion protocol in your hospital:

    1. Are you given packs of FFP according to how many units of blood
have been administered?
        (eg. 2 units of FFP after every 6 units of blood)

    2. How much FFP after how much blood?

    3. If your answer to (1) was NO, what's the make-up of your packs

B. If you have just administered 6 units of blood:

    1. Do you always give a certain amount of FFP or do you wait for
labs? Which labs?

    2. If you give FFP, how much for those 6 units would you consider
standard?

    3. What is the minimum that should be given (0 is an acceptable
answer)

C. Labs:

    1. You send a PT/PTT from the ED or Operating room.  How soon do you
get it back? (really)

    2. Do you have point of care testing for PT/PTT in the ED & OR?

    3. Do you do thromboelastometry routinely on bleeding trauma
patients in the ED and OR?

There are no right or wrong answers, as practice varies so widely.  I'm just
trying to see the breadth of responses. So as many replies as possible
please - even from the lurkers :-)

Karim

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Massive Transfusion Protocol: What's in YOUR pack?