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Usage of Blood Products in Multiple-Casualty Incidents—Invited Critique

Usage of Blood Products in Multiple-Casualty Incidents—Invited Critique Accurate estimation of the need for blood products during MCIs is vital to providing these lifesaving resources when health care systems are under their greatest stress. In this era of terrorist activity, the most likely event will be a bombing, and thus we can learn a great deal from the experience gained in Israel where these incidents have been all too common. The article by Soffer et al provides a retrospective review of the use of PRBCs following 18 consecutive terrorist attacks in Tel Aviv between 1997 and 2005. They define a PRBC unit per admitted patient ratio index, which may be useful in planning the number of units of PRBCs to keep available for such events. More importantly, they also describe a standard operating procedure for notification and activation of the blood bank during an MCI that could be adapted for use by trauma systems throughout the world. What's missing from this description of blood product needs, however, is the early use of coagulation factors such as FFP, platelets, and cryoprecipitate. More than 50% of the blood transfused was used by 5% of patients requiring a massive transfusion (>10 U of PRBCs within 24 hours). As acknowledged by the authors, during this study period their massive transfusion protocol did not initiate the transfusion of these factors until after 6 U of PRBCs had been transfused, and as a result patients did not receive factors until more than 2 hours after admission. Recent studies1,2 have emphasized the need to transfuse FFP much earlier. Data from the management of combat casualties in Iraq have suggested administering a 1:1 ratio of PRBCs to FFP to those requiring a massive transfusion.1,2 If these data are confirmed, this will have implications for blood banks to ensure the immediate availability of coagulation products in addition to PRBCs. Early administration of these products may minimize dilutional coagulopathy and ultimately reduce the number of PRBCs required. Further study in this area is clearly warranted to optimize planning for future events. Correspondence: Dr Bulger, Harborview Medical Center, Box 359796, 325 Ninth Ave, Seattle, WA 98104-2499 (ebulger@u.washington.edu). Financial Disclosure: None reported. References 1. Gonzalez EAMoore FAHolcomb JB et al. Fresh frozen plasma should be given earlier to patients requiring massive transfusion. J Trauma 2007;62 (1) 112- 119PubMedGoogle ScholarCrossref 2. Geeraedts LM JrDemiral HSchaap NPKamphuisen PWPompe JCFrolke JP “Blind” transfusion of blood products in exsanguinating trauma patients. Resuscitation 2007;73 (3) 382- 388PubMedGoogle ScholarCrossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Usage of Blood Products in Multiple-Casualty Incidents—Invited Critique

Bulger, Eileen M.
Archives of Surgery , Volume 143 (10) – Oct 20, 2008
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Usage of Blood Products in Multiple-Casualty Incidents—Invited Critique

Abstract

Accurate estimation of the need for blood products during MCIs is vital to providing these lifesaving resources when health care systems are under their greatest stress. In this era of terrorist activity, the most likely event will be a bombing, and thus we can learn a great deal from the experience gained in Israel where these incidents have been all too common. The article by Soffer et al provides a retrospective review of the use of PRBCs following 18 consecutive terrorist attacks in Tel...
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Publisher
American Medical Association
Copyright
Copyright © 2008 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.2008.3
Publisher site
See Article on Publisher Site

Abstract

Accurate estimation of the need for blood products during MCIs is vital to providing these lifesaving resources when health care systems are under their greatest stress. In this era of terrorist activity, the most likely event will be a bombing, and thus we can learn a great deal from the experience gained in Israel where these incidents have been all too common. The article by Soffer et al provides a retrospective review of the use of PRBCs following 18 consecutive terrorist attacks in Tel Aviv between 1997 and 2005. They define a PRBC unit per admitted patient ratio index, which may be useful in planning the number of units of PRBCs to keep available for such events. More importantly, they also describe a standard operating procedure for notification and activation of the blood bank during an MCI that could be adapted for use by trauma systems throughout the world. What's missing from this description of blood product needs, however, is the early use of coagulation factors such as FFP, platelets, and cryoprecipitate. More than 50% of the blood transfused was used by 5% of patients requiring a massive transfusion (>10 U of PRBCs within 24 hours). As acknowledged by the authors, during this study period their massive transfusion protocol did not initiate the transfusion of these factors until after 6 U of PRBCs had been transfused, and as a result patients did not receive factors until more than 2 hours after admission. Recent studies1,2 have emphasized the need to transfuse FFP much earlier. Data from the management of combat casualties in Iraq have suggested administering a 1:1 ratio of PRBCs to FFP to those requiring a massive transfusion.1,2 If these data are confirmed, this will have implications for blood banks to ensure the immediate availability of coagulation products in addition to PRBCs. Early administration of these products may minimize dilutional coagulopathy and ultimately reduce the number of PRBCs required. Further study in this area is clearly warranted to optimize planning for future events. Correspondence: Dr Bulger, Harborview Medical Center, Box 359796, 325 Ninth Ave, Seattle, WA 98104-2499 (ebulger@u.washington.edu). Financial Disclosure: None reported. References 1. Gonzalez EAMoore FAHolcomb JB et al. Fresh frozen plasma should be given earlier to patients requiring massive transfusion. J Trauma 2007;62 (1) 112- 119PubMedGoogle ScholarCrossref 2. Geeraedts LM JrDemiral HSchaap NPKamphuisen PWPompe JCFrolke JP “Blind” transfusion of blood products in exsanguinating trauma patients. Resuscitation 2007;73 (3) 382- 388PubMedGoogle ScholarCrossref

Journal

Archives of Surgery – American Medical Association

Published: Oct 20, 2008

Keywords: blood products

References

  • Fresh frozen plasma should be given earlier to patients requiring massive transfusion.
    Holcomb JB; J Trauma
  • “Blind” transfusion of blood products in exsanguinating trauma patients.
    Frolke JPResus