Massive transfusion practice in non-trauma related hemorrhagic shock

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Purpose:Evidence suggests that trauma patients with hemorrhagic shock requiring massive transfusion have improved outcomes if resuscitated with a prescribed massive transfusion protocol (MTP). However, there is limited data regarding the efficacy of MTP in non-trauma patients.Methods:This was a retrospective observational study of all patients who received a massive transfusion protocol for non-traumatic hemorrhagic shock over a four-year period. The primary outcome was in-patient hospital survival. We dichotomized recipients of MTP into survivors versus non-survivors, comparing outcomes of interest within the categories by nonparametric testing. Summary statistics expressed as median (interquartile range).Results:Fifty-nine patients were reviewed, with the median age of 59.0 (35.0–71.0) years old. Thirty-three (56%) patients survived. Survivors were younger, 57.0 (30.0–67.0) versus 64.0 (53.5–71.5) years old (p = 0.047), and had lower Sequential Organ Failure Assessment scores (6.0 (3.0–8.0) versus11.5 (9.5–13.0); p = 0.008). Patients on the medical service receiving MTP had an increased risk of mortality (odds ratio 4.26; p = 0.02).Conclusion:Over half of the patients receiving massive transfusion protocols for their non-trauma related hemorrhagic shock survived. Survivors were younger, were less acutely ill, and on non-medical services. Further research is needed to investigate best practice for transfusion in non-trauma related hemorrhagic shock.

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