A couple days ago, @karimbrohi drew a bit of attention to this article on Twitter:
Compliance with Massive Transfusion Protocol improves outcome: http://t.co/Z2yf3EOQeM [Protocol followed- 10% mortality. Not followed – 60%]
— Karim Brohi (@karimbrohi) January 3, 2015
Massive transfusion protocols are, essentially, the standard of care in advanced trauma care. Coordinated systems to produce timely quantities of appropriate blood products are nothing new. However, the contemporary usage of MTP has been to describe a protocol with fixed ratio of product – usually approximating a 1:1 ratio of PRBCs and FFP, and some programs include platelets.
This small study retrospectively evaluated the survival of 72 consecutive MTP activations at their trauma facility. Compliance with 13 quality measures associated with resuscitation and transfusion was 66% overall. Mortality rates in the cohorts with <60% compliance, 60-80% compliance, and >80% compliance with quality measures were 62%, 50%, and 10%, respectively. Thus – compliance saves lives!
Maybe?
Tables 4 and 5 compare the baseline characteristics between survivors and non-survivors – and, frankly, it’s hard to decisively say “compliance” made the difference. Worse initial GCS, median ISS, and AIS head/spine were all significantly associated with poorer outcomes. Then, as far as differences in “compliance”, there was actually little difference between survivors and non-survivors regarding actual issuing and receipt of blood products. Rather, the differences were in the quality measures associated with specific lab work – and hypothermia correction, which suffered greatly in non-survivors, almost certainly because they were in the OR for heroic measures rather than in the ICU. So, it’s rather difficult to reliably state the quality of care was lower for those who did not survive.
And certainly not to account for the entire magnitude of this 60% to 10% mortality advantage!
“Compliance with a massive transfusion protocol (MTP) impacts patient outcome”
http://www.ncbi.nlm.nih.gov/pubmed/25452004