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Massive Transfusion Protocol: Does it translate into improved outcomes in postpartum hemorrhage? A retrospective cohort study.
Abstract Number: SA-04
Abstract Type: Original Research
Introduction: Over the past decade, Massive Transfusion Protocols (MTP) have been developed and proposed to advance the severe postpartum hemorrhage (PPH) management. MTPs main goal is to synchronize surgical, anesthesia, laboratory and blood bank responses in an immediate and sustainable manner. The MTPs clinical impact in obstetrics is yet to be determined. This study was undertaken to compare the massive transfusion management and clinical outcomes in a labor and delivery unit where MTP is implemented (MTP+) to another where no MTP is implemented (MTP-).
Methods: After obtaining REB approval, Health Record archives of two centres with more than 4000 deliveries a year, were approached to identify all hospitalization of patients that required at least 5 units of red blood cell (RBC) transfusion in the first 24 hours after delivery. In one centre, a specific obstetrical MTP was implemented and running (MTP+) and in the MTP- centre, no MTP was in place. The sampling method was a convenient one including all consecutive obstetric patients between September 2010 and January 2015. Demographic, Obstetrical, management data and outcomes (48 hours survival; mechanical ventilation, length of stay in ICU and hospital; sepsis, acute renal failure; acute respiratory distress syndrome and multiple organ failure) were extracted retrospectively from patient hospital records. Statistical analysis: Student t and Chi-square tests were applied when appropriate (SPSS V20 package; statistical significance at P<0.05).
Results: The main results are presented in Table 1. The 48 hours survival was 100% in both centres.
Table 1. Demographic, obstetrical, management and outcomes data (mean± standard deviation/frequencies and percentages)
Discussion: Considering the massive transfusion management, the main finding was that the frequency of tranexamic acid administration was significantly higher in the MTP+ centre (P=0.003). Of note, both centres presented low FFP:RBC transfusion ratio (below 0.5). In the MTP+ centre patients stayed longer in hospital but shorter in ICU (P=0.008 and P<0.001, respectively). As it is a retrospective study, reporting bias and cofounding factors cannot be ignored. Massive Transfusion in Obstetric is an important but rare event. Larger multicentre studies are warranted to determine the MTP clinical impact in obstetrical settings.
References: 1) J trauma 2010;68(6):1498-1505. 2) IJOG 2012;21(3):230-5. 3) AJOG 2013;209(5):449 e441-7.