Massive transfusion protocols aim to replace lost blood volume and prevent coagulopathy in severely injured trauma patients. The study found that 7% of trauma patients received over 10 units of red blood cells in the first 24 hours, identifying them at high risk. Early administration of blood products in a 1:1:1 ratio of red cells, plasma, and platelets according to massive transfusion protocols was associated with reduced mortality compared to standard transfusion practices. Simple clinical factors like low blood pressure, high injury severity score, and coagulopathy can help predict patients needing massive transfusion.

1. Massive transfusion in trauma R.Sinha, D.Roxby, R.Seshadri Flinders Medical Centre, SA

8. Injury Severity Score (ISS) ISS (median) Overall 38 (27-48) Survivors 29 (22-41) Non-survivors 49 (41-57 )

9. Injury regions 80% of the patients had multiple injuries 08 (10%) Injury to extremities 09 (11%) Facial injuries 47 (59%) Limbs 38 (48%) Injuries to abdomen and pelvis 51 (64%) Chest injuries 42 (53%) Head or neck injuries Patients (%) Different regions

10. Blood products used Units 24hrs Median,IQR Units 6hrs Median,IQR 1603 18 (12-28) 1221 13 (9-20) Red cells 679 7 (4-11) 431 4 (2-8) FFP 145 2 (1-3) 80 1 (0-2) Platelets 12 0 4 0 Cryo 2.5 (1.8-3.3) 2.8 (2.0-3.8) RC:FFP 11(9-12) 11(9-15) RC:PLT

11. Blood products used 0.20 21(13-31) 17 (12-23) RC (24hrs) 0.40 8 (5-13) 6 (4-10) FFP (24hrs) 0.41 2(1-3) 1 (1-3) PLTS (24hrs) 0.66 2.4:1 2.5:1 RC:FFP (24hrs) 0.85 11:1 10.5:1 RC:PLT (24hrs) 26 54 Patients 0.01 18(11-26) 12 (9-17) RC (6hrs) 0.03 7(4-9) 4 (2-8) FFP (6hrs) 0.02 1(0.8-2) 2 (0-1) PLTS (6hrs) 0.60 2.6:1 2.8:1 RC:FFP (6hrs) 0.78 11.4:1 11:1 RC:PLT (6hrs) p-value Non-survivors Survivors

12. Where are they transfused? 21% of the total units transfused –uncrossmatched O negative or group specific units ICU OT Resuscitation Retrieval Location 57 ( 71%) 60 (75%) 56 (70%) 24 (30%) Patients

17. Massive Transfusion Pack

18. Schedule for Massive Transfusion Response Pack RC FFP PLT Cryo rFVIIa 1 5 (O Neg) 2-4 (AB) 1 2 5 4 2 2 3 5 4 2 2 *** 4 5 4 2 5 5 4 2 6 5 4 2 2 7 5 4 2 8 5 4 2 9 5 4 2 2 10 5 4 2

21. Thank you