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Implementation of a Massive Transfusion Protocol Improves Blood Product Delivery Practices in Patients with Severe Postpartum Hemorrhage
Abstract Number: F 33
Abstract Type: Original Research
Background: Postpartum hemorrhage (PPH) is a major cause of maternal morbidity and massive PPH is a leading cause of maternal mortality worldwide. Recent studies suggest that a transfusion ratio of platelets to fresh frozen plasma (FFP) to red blood cells (RBC) of 1:1:1 may be beneficial in cases of massive postpartum hemorrhage as has been shown in patients with other forms of massive bleeding (1). At our institution, we initiated a Massive Transfusion Protocol (MTP) in March, 2011, along with a multidisciplinary educational program regarding the benefits of appropriate transfusion ratios for massive hemorrhage. The primary objective of this study was to determine whether our program and MTP altered PPH transfusion practices.
Methods: Data from the Johns Hopkins Hospital Blood Bank were obtained from January, 2010 to June, 2012 and those patients admitted to Labor and Delivery requiring massive transfusion (MT) were included. MT was defined as transfusion of ten or more units of RBCs. Ratios of FFP to RBCs and platelets to RBCs were calculated for each patient and analyzed in two groups, those occurring before implementation of the MTP and those occurring after. An unpaired t-test was used to compare pre and post-MTP data, and P < 0.05 defined significance.
Results: 19 women admitted to Labor and Delivery met inclusion criteria. There were nine cases pre-MTP and ten cases occurring post-MTP. Overall, the FFP to RBC ratio was 0.32 pre-MTP and 0.81 post-MTP (P=0.0005). The platelet to RBC ratio was 0.82 pre-MTP and 1.27 post-MTP (P=0.13) (Figure 1). Of the 9 cases occurring after implementation of the MTP, only 3 cases officially activated the protocol.
Conclusion: In cases of massive PPH, implementation of an educational program and MTP led to a significantly greater FFP to RBC ratio. This improvement was noted even in cases that did not officially activate the protocol. Possible explanations include greater awareness for the 1:1:1 ratio through the large educational effort that occurred with the implementation of the MTP, or that the Blood Bank was able to thaw and issue FFP more quickly after obtaining new equipment in support of MTP activations. The increase in platelet to RBC ratio was not significant, possibly because it was already close to 1:1 in the pre-MTP time period.
1. Pasuqier, P, Gayat E, Rackleboom T, et al. Anesthesia and Analgesia. 2013; 116: 155-161.