Traumacast EAST/AAST/AAST-AMC: SCC Review Series - Hematology I
Mar 28, 2025
Dr. Brian Yorkgitis, Chief of Acute Care Surgery at IU Health, and Dr. Linda Schutzman, Assistant Professor of Surgery at IU Health, share their expertise in surgical critical care. They dive into the implementation of Massive Transfusion Protocols and the revival of whole blood transfusions, emphasizing evidence-based practices. The conversation highlights the significance of DVT prophylaxis in trauma care and the complexities of thrombosis post-trauma, particularly with pulmonary embolisms. Their insights bridge the gap between traditional approaches and modern advancements in patient care.
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ABC Score for MTP Activation
- The ABC score helps decide when to start Massive Transfusion Protocol (MTP), focusing on pulse, blood pressure, positive FAST, or penetrating injury.
- It has high negative predictive value but a moderate positive predictive value, so it overestimates who actually needs MTP.
Blood Product Ratios in MTP
- Deliver blood components in a 1:1 to 1:2 ratio of RBC to plasma with platelets every 6 units of RBC.
- Keep blood products ready in coolers and deliver them at 15-minute intervals during MTP.
Evidence for Balanced Transfusion Ratios
- Early component therapy transfusion improves outcomes by replacing all lost blood components, not just red cells.
- The PROPPR trial showed balanced 1:1:1 transfusion improved hemostasis in exsanguinating trauma patients.