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Massive transfusion: New Protocol Bhavani Shankar Kodali MD Anesthesiologist-in-Chief, Interim Chairman Brigham and Women’s Hospital Associate Professor.

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Presentation on theme: "Massive transfusion: New Protocol Bhavani Shankar Kodali MD Anesthesiologist-in-Chief, Interim Chairman Brigham and Women’s Hospital Associate Professor."— Presentation transcript:

1 Massive transfusion: New Protocol Bhavani Shankar Kodali MD Anesthesiologist-in-Chief, Interim Chairman Brigham and Women’s Hospital Associate Professor Harvard Medical School

2 Goal of this presentation Are we on the right track? What is our current practice?

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4 “Obstetrics Anesthesia”

5 “Obstetrics is a bloody business”

6 1970’s - maternal deaths due to bleeding = 13% 1990’s - maternal deaths due to bleeding ~ 1.3% Presently - 1 per 100, % maternal deaths Worldwide Preventable

7 Conventional Management of Hemorrhage Fluids Colloids Blood Plasma 3:1 Platelets depending on the number

8 246

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10 22 Level 1 trauma

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13 Obstetric hemorrhage

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15 Whole Blood Bedside Assay

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19 platelets

20 **Balanced ratios of blood products **Blood viscoelastic assays

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24 Initial Labs

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26 How did we achieve these results 1:1:1 Cryoprecipitate Ca Temperature of the patient RiaSTAP

27 Massive Transfusion Department of Anesthesiology, Perioperative and Pain Medicine Brigham and Women’s Hospital

28 Massive Transfusion Definition –Transfusion of ≥10 units of blood products in 24 hours –Replacement by transfusion of more than 50% of blood volume in 12 to 24 hours Hemorrhage is the leading cause of death in the first hour after trauma and accounts for 50% of death in the first 24 hours

29 Coagulopathy Coagulopathy is associated with trauma in 25-38% of patients; it is also associated with a 4-fold increase in mortality Acute Coagulopathy of Trauma (ACoT) –Associated with severe injury –PT, aPTT, thrombin time >1.5 times normal limit –Coagulopathy: higher mortality (46% vs. 11%) 1 1 Brohi K et al J Trauma 2003

30 Assessment of Coagulopathy Early recognition is associated with improved survival Conventional coagulation testing (PT, PTT, platelet count, fibrinogen) Rapid Thromboelastography (TEG) –Comprehensive assessment of coagulation abnormalities –Faster results –Correlated with conventional testing

31 Activating Massive Transfusion Protocol at BWH Pharmacy = x27153 Blood bank = x27290 Criteria at BWH –> 4 PRBC in 1 hour –> 10 PRBC in 24 hours

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