1
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Cannon JW, Igra NM, Borge PD, Cap AP, Devine D, Doughty H, Geng Z, Guzman JF, Ness PM, Jenkins DH, Rajbhandary S, Schmulevich D, Stubbs JR, Wiebe DJ, Yazer MH, Spinella PC. U.S. cities will not meet blood product resuscitation standards during major mass casualty incidents: Results of a THOR-AABB working party prospective analysis. Transfusion 2022; 62 Suppl 1:S12-S21. [PMID: 35730720 DOI: 10.1111/trf.16960] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/27/2022] [Accepted: 02/01/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Mass casualty incidents (MCIs) create an immediate surge in blood product demand. We hypothesize local inventories in major U.S. cities would not meet this demand. STUDY DESIGN AND METHODS A simulated blast in a large crowd estimated casualty numbers. Ideal resuscitation was defined as equal amounts of red blood cells (RBCs), plasma, platelets, and cryoprecipitate. Inventory was prospectively collected from six major U.S. cities at six time points between January and July 2019. City-wide blood inventories were classified as READY (>1 U/injured survivor), DEFICIENT (<10 U/severely injured survivor), or RISK (between READY and DEFICIENT), before and after resupply from local distribution centers (DC), and features of DEFICIENT cities were identified. RESULTS The simulated blast resulted in 2218 injured survivors including 95 with severe injuries. Balanced resuscitation would require between 950 and 2218 units each RBC, plasma, platelets and cryoprecipitate. Inventories in 88 hospitals/health systems and 10 DCs were assessed. Of 36 city-wide surveys, RISK inventories included RBCs (n = 16; 44%), plasma (n = 24; 67%), platelets (n = 6; 17%), and cryoprecipitate (n = 22; 61%) while DEFICIENT inventories included platelets (n = 30; 83%) and cryoprecipitate (n = 12; 33%). Resupply shifted most RBC and plasma inventories to READY, but some platelet and cryoprecipitate inventories remained at RISK (n = 24; 67% and n = 12; 33%, respectively) or even DEFICIENT (n = 11; 31% and n = 6; 17%, respectively). Cities with DEFICIENT inventories were smaller (p <.001) with fewer blood products per trauma bed (p <.001). DISCUSSION In this simulated blast event, blood product demand exceeded local supply in some major U.S. cities. Options for closing this gap should be explored to optimize resuscitation during MCIs.
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Affiliation(s)
- Jeremy W Cannon
- Division of Traumatology, Surgical Critical Care & Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Surgery, Uniformed Services University F. Edward Hébert School of Medicine, Bethesda, Maryland, USA
| | - Noah M Igra
- Division of Traumatology, Surgical Critical Care & Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Sackler School of Medicine at Tel Aviv University, Tel Aviv, Israel
| | - P Dayand Borge
- Biomedical Services, American Red Cross, Philadelphia, Pennsylvania, USA
| | - Andrew P Cap
- U.S. Army Institute of Surgical Research, Joint Base San Antonio-FT Sam, Houston, Texas, USA
| | - Dana Devine
- Canadian Blood Services, Vancouver, British Columbia, Canada
| | - Heidi Doughty
- NIHR Surgical Reconstruction and Microbiology Research Centre, Institute of Translational Medicine, Birmingham, UK
| | - Zhi Geng
- Division of Traumatology, Surgical Critical Care & Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jessica F Guzman
- Department of Surgery, University of California Davis Medical Center, Sacramento, California, USA
| | - Paul M Ness
- Department of Pathology, Division of Transfusion Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Donald H Jenkins
- Department of Surgery, Division of Trauma and Emergency Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | | | - Daniela Schmulevich
- Division of Traumatology, Surgical Critical Care & Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Douglas J Wiebe
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Penn Injury Science Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mark H Yazer
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Philip C Spinella
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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2
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Williams J, Gustafson M, Bai Y, Prater S, Wade CE, Guillamondegui OD, Khan M, Brenner M, Ferrada P, Roberts D, Horer T, Kauvar D, Kirkpatrick A, Ordonez C, Perreira B, Priouzram A, Duchesne J, Cotton BA. Limitations of Available Blood Products for Massive Transfusion During Mass Casualty Events at US Level 1 Trauma Centers. Shock 2021; 56:62-69. [PMID: 33470606 PMCID: PMC8601667 DOI: 10.1097/shk.0000000000001719] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 12/26/2019] [Accepted: 01/04/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Exsanguination remains a leading cause of preventable death in traumatically injured patients. To better treat hemorrhagic shock, hospitals have adopted massive transfusion protocols (MTPs) which accelerate the delivery of blood products to patients. There has been an increase in mass casualty events (MCE) worldwide over the past two decades. These events can overwhelm a responding hospital's supply of blood products. Using a computerized model, this study investigated the ability of US trauma centers (TCs) to meet the blood product requirements of MCEs. METHODS Cross-sectional survey data of on-hand blood products were collected from 16 US level-1 TCs. A discrete event simulation model of a TC was developed based on historic data of blood product consumption during MCEs. Each hospital's blood bank was evaluated across increasingly more demanding MCEs using modern MTPs to guide resuscitation efforts in massive transfusion (MT) patients. RESULTS A total of 9,000 simulations were performed on each TC's data. Under the least demanding MCE scenario, the median size MCE in which TCs failed to adequately meet blood product demand was 50 patients (IQR 20-90), considering platelets. Ten TCs exhaust their supply of platelets prior to red blood cells (RBCs) or plasma. Disregarding platelets, five TCs exhausted their supply of O- packed RBCs, six exhausted their AB plasma supply, and five had a mixed exhaustion picture. CONCLUSION Assuming a TC's ability to treat patients is limited only by their supply of blood products, US level-1 TCs lack the on-hand blood products required to adequately treat patients following a MCE. Use of non-traditional blood products, which have a longer shelf life, may allow TCs to better meet the blood product requirement needs of patients following larger MCEs.
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Affiliation(s)
- James Williams
- The Center for Translational Injury Research, The McGovern Medical School at the University of Texas Health Science Center, Houston, Texas
- Department of Surgery, The McGovern Medical School at the University of Texas Health Science Center, Houston, Texas
| | - Michael Gustafson
- Duke University Pratt School of Engineering, The McGovern Medical School at the University of Texas Health Science Center, Houston, Texas
| | - Yu Bai
- Pathology and Laboratory Medicine, The McGovern Medical School at the University of Texas Health Science Center, Houston, Texas
- Department of Emergency Medicine, The McGovern Medical School at the University of Texas Health Science Center, Houston, Texas
| | - Samuel Prater
- Department of Emergency Medicine, The McGovern Medical School at the University of Texas Health Science Center, Houston, Texas
- Department of Surgery, The Red Duke Trauma Institute at Memorial Hermann Hospital, Texas Medical Center, Houston, Texas
| | - Charles E. Wade
- The Center for Translational Injury Research, The McGovern Medical School at the University of Texas Health Science Center, Houston, Texas
- Department of Surgery, The McGovern Medical School at the University of Texas Health Science Center, Houston, Texas
| | | | - Mansoor Khan
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, UK
| | - Megan Brenner
- Department of Surgery, University of California Riverside, Riverside, California
| | - Paula Ferrada
- VCU Surgery Trauma, Critical Care and Emergency Surgery, Richmond, Virginia
| | - Derek Roberts
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Tal Horer
- Department of Cardiothoracic and Vascular Surgery, Faculty of Life Science Örebro University Hospital and University, Örebro, Sweden
| | - David Kauvar
- Vascular Surgery Service, San Antonio Military Medical Center, San Antonio, Texas
| | - Andrew Kirkpatrick
- Regional Trauma Services Foothills Medical Centre, Calgary, Alberta, Canada
- Departments of Surgery, Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
- Canadian Forces Health Services, Calgary, Alberta, Canada
| | - Carlos Ordonez
- Fundación Valle del Lili, Division of Trauma and Acute Care Surgery, Department of Surgery, Universidad del Valle, Cali, Valle del Cauca, Colombia
| | - Bruno Perreira
- Department of Surgery and Surgical Critical Care, University of Campinas, Campinas, Brazil
| | - Artai Priouzram
- Department of Cardiothoracic and Vascular Surgery, Linköping University Hospital, Linköping, Sweden
| | - Juan Duchesne
- Division Chief Acute Care Surgery, Department of Surgery Tulane, New Orleans, Louisiana
| | - Bryan A. Cotton
- The Center for Translational Injury Research, The McGovern Medical School at the University of Texas Health Science Center, Houston, Texas
- Department of Surgery, The McGovern Medical School at the University of Texas Health Science Center, Houston, Texas
- Department of Surgery, The Red Duke Trauma Institute at Memorial Hermann Hospital, Texas Medical Center, Houston, Texas
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Gammon RR, Rosenbaum L, Cooke R, Friedman M, Rockwood L, Nichols T, Vossoughi S. Maintaining adequate donations and a sustainable blood supply: Lessons learned. Transfusion 2020; 61:294-302. [PMID: 33206404 PMCID: PMC7753343 DOI: 10.1111/trf.16145] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 08/10/2020] [Accepted: 08/10/2020] [Indexed: 01/28/2023]
Abstract
Background The availability of a safe blood supply is a key component of transfusion medicine. A decade of decreased blood use, decreased payment for products, and a dwindling donor base have placed the sustainability of the US blood supply at risk. Study Design and Methods A literature review was performed for blood center (BC) and hospital disaster management, chronically transfusion‐dependent diseases, and appropriate use of group O‐negative red blood cells (RBCs), and the Choosing Wisely campaign. The aim was to identify current practice and to make recommendations for BC and hospital actions. Results While BCs are better prepared to handle disasters than after the 9/11 attacks, messaging to the public remains difficult, as donors often do not realize that blood transfused during a disaster was likely collected before the event. BCs and transfusion services should participate in drafting disaster response plans. Hospitals should maintain inventories adequate for patients in the event supply is disrupted. Providing specialty products for transfusion‐dependent patients can strain collections, lead to increased use of group O RBCs, and create logistical inventory challenges for hospitals. The AABB Choosing Wisely initiative addresses overuse of blood components to optimally use this precious resource. Group O‐negative RBCs should be transfused only to patients who truly need them. Conclusions Collecting and maintaining a blood supply robust enough to handle disasters and transfusion‐dependent patients in need of specialty products is challenging. Collaboration of all parties should help to optimize resources, ensure appropriate collections, improve patient care, and ultimately result in a robust, sustainable blood supply.
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Affiliation(s)
- Richard R Gammon
- Scientific Medical and Technical Direction, OneBlood, Inc., Orlando, Florida, USA
| | | | - Rhonda Cooke
- Missouri Baptist Medical Center, St. Louis, Missouri, USA
| | - Mark Friedman
- Transfusion Service, NYU Winthrop Hospital, Mineola, New York, USA
| | - Linda Rockwood
- New England Baptist Hospital, Boston, Massachusetts, USA
| | - Tracie Nichols
- Blood Bank, West Virginia University Hospitals, Morgantown, West Virginia, USA
| | - Sarah Vossoughi
- Department of Pathology & Cell Biology, Columbia University, New York, New York, USA
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4
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Chhibber VG, Fischman J, Benedetto AT, Nikolis NM, Indrikovs AJ, Shariatmadar S. How do I manage O- red blood cell inventory. Transfusion 2020; 60:1356-1363. [PMID: 32500565 DOI: 10.1111/trf.15849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 04/02/2020] [Accepted: 04/02/2020] [Indexed: 11/28/2022]
Abstract
Currently there are no widely accepted guidelines regarding the appropriate use of O- red blood cells (RBCs). Although there has been a decline in overall RBC utilization since 2010, the use of O- RBCs has continued to proportionally increase over this time period resulting in frequent shortages. When faced with these shortages, we implemented some simple strategies that resulted in a significant decrease in annual O- RBC utilization from 10% to 7.5% despite an increase in total RBC utilization. These strategies included collaboration with the clinical staff, improving practices within the blood bank, and having our health system partner with our blood supplier. Herein, we detail our strategies for hospital transfusion services to improve O- RBC utilization. Most of these can be easily implemented and do not require additional resources.
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Affiliation(s)
| | - Jane Fischman
- North Shore University Hospital, Manhasset, New York, USA
| | | | | | | | - Sherry Shariatmadar
- Northwell Health, Manhasset, New York, USA.,North Shore University Hospital, Manhasset, New York, USA
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5
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Ramsey G. Blood transfusions in mass casualty events: recent trends. Vox Sang 2020; 115:358-366. [PMID: 32253763 DOI: 10.1111/vox.12916] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 02/20/2020] [Accepted: 03/10/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND OBJECTIVES The US AABB disaster task force recommends estimating 3 RBC units per admission (UPA) for mass casualty events (MCEs). In a previous analysis, median MCE UPA were 2·7 RBCs, 1·2 plasmas and 0·27 platelet doses (Vox Sang 2017; 112:648). Additional recent data were sought from the current era of balanced massive transfusion protocols (bMTPs). MATERIALS AND METHODS Publications in English from 1980 to 2020 were reviewed for MCEs using ≥50 RBCs/event and with numbers of admissions available. MCE reports were stratified by era and event-wide or trauma-centre source. The bMTP era included all MCEs since 2010 plus a 2008 bMTP military report. STATISTICS Mann-Whitney test. RESULTS Thirty-two MCEs met analysis criteria. Event-wide reports used medians [interquartile ranges] of 1·8 [1·2-3·9] RBC, 0·6 [0·3-0·9] plasma and 0·14 [0·06-0·26] platelet-dose UPA. Trauma centres transfused 3·4 [2·7-6·3] RBC, 2·4 [1·3-4·1] plasma and 0·41 [0·34-0·50] platelet-dose UPA, all P < 0·05 vs event-wide. Same-event median post-day-1 transfusions were 50% of day-1 use for RBC, 28% for plasma and 16% for platelets. Compared to prior years, the median plasma/RBC transfusion ratio rose from 0·28 to 0·67 in the bMTP era (P < 0·01). In recent mass shootings, trauma centres transfused up to 42 platelets (range 0·45-0·57 UPA) on day 1. CONCLUSION Based on available mass casualty data, we recommend planning for 3 RBC, 1 plasma and one-fourth platelet-dose units per admission for blood centres (event-wide), and 6, 4 and one-half UPA, respectively, for trauma centres, which have seen rising plasma usage and large mass-shooting platelet needs.
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Affiliation(s)
- Glenn Ramsey
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Evanston, Illinois, USA.,Blood Bank, Department of Pathology, Northwestern Memorial Hospital, Chicago, Illinois, USA
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6
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Badami KG, Mercer S, Chiu M, Yi M, Warrington S. Analysis of transfusion therapy during the March 2019 mass shooting incident in Christchurch, New Zealand. Vox Sang 2020; 115:424-432. [DOI: 10.1111/vox.12907] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 02/09/2020] [Accepted: 02/10/2020] [Indexed: 12/18/2022]
Affiliation(s)
| | - Susan Mercer
- New Zealand Blood Service Christchurch New Zealand
| | - May Chiu
- New Zealand Blood Service Christchurch New Zealand
| | - Ma Yi
- Canterbury District Health Board Christchurch New Zealand
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7
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Doughty H, Rackham R. Transfusion emergency preparedness for mass casualty events. ACTA ACUST UNITED AC 2018. [DOI: 10.1111/voxs.12448] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Heidi Doughty
- NHS Blood and Transplant; Birmingham UK
- NIHR Surgical Reconstruction and Microbiology Research Centre; Queen Elizabeth Hospital; Birmingham UK
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8
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Affiliation(s)
- Harvey G Klein
- From the Department of Transfusion Medicine, National Institutes of Health, Bethesda, MD (H.G.K.); and the American National Red Cross Biomedical Services (J.C.H.) and the Office of Blood Research and Review, Center for Biologics Evaluation and Research, Food and Drug Administration (J.S.E.) - both in Washington, DC
| | - J Chris Hrouda
- From the Department of Transfusion Medicine, National Institutes of Health, Bethesda, MD (H.G.K.); and the American National Red Cross Biomedical Services (J.C.H.) and the Office of Blood Research and Review, Center for Biologics Evaluation and Research, Food and Drug Administration (J.S.E.) - both in Washington, DC
| | - Jay S Epstein
- From the Department of Transfusion Medicine, National Institutes of Health, Bethesda, MD (H.G.K.); and the American National Red Cross Biomedical Services (J.C.H.) and the Office of Blood Research and Review, Center for Biologics Evaluation and Research, Food and Drug Administration (J.S.E.) - both in Washington, DC
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9
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Ramsey G. Blood component transfusions in mass casualty events. Vox Sang 2017; 112:648-659. [PMID: 28891209 DOI: 10.1111/vox.12564] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 07/06/2017] [Accepted: 07/10/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES Planning transfusion needs in mass casualty events (MCE) is critical for disaster preparedness. Published data on blood component usage were analysed to seek correlative factors and usage rates. MATERIALS AND METHODS English-language medical publications since 1980 were searched for MCEs with numbers of patient admissions and transfused RBCs. Reports were excluded from natural disasters or with total RBC use <50 units. Statistical analysis employed Mann-Whitney U-tests and Spearman's rank correlations. RESULTS In 24 reports, the average units per admission were 3·06 RBCs, 2·13 plasmas and 0·37 platelet doses. Five RBCs per admission would have sufficed for 87% of events. Transfusion needs involving bombings correlated with admissions (P ≤ 0·03). In the formula (massive-transfusion patients in MCE) times X = (total units for all MCE patients), the average X was 35 for RBCs (correlation P = 0·01), 17 for plasma (P = 0·10) and five for platelet doses (P = 0·06). From 67% to 84% of all components used were given in the first 24 h (event medians). CONCLUSIONS Blood component use in MCEs correlated with numbers of patients admitted or receiving massive transfusion. More current data are needed to better reflect emerging trauma care practices and refine predictive models of transfusion needs.
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Affiliation(s)
- G Ramsey
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Department of Pathology, Northwestern Memorial Hospital, Chicago, IL, USA.,Blood Bank, Northwestern Memorial Hospital, Chicago, IL, USA
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10
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Comprehensive Evaluation of Coagulation in Swine Subjected to Isolated Primary Blast Injury. Shock 2015; 43:598-603. [DOI: 10.1097/shk.0000000000000346] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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