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1.
A systematic review of indications when and how a military walking Blood Bank could bridge blood product unavailability
Degueldre, J., Dessy, E., T'Sas, F., Deneys, V.
Blood transfusion = Trasfusione del sangue. 2024
Abstract
BACKGROUND Blood supply problems in remote areas are well known. To overcome this shortage, many countries have developed innovative Walking Blood Bank (WBB) protocols. However, no common standards have yet been set for their use and common actions. Given that these procedures involve a certain risk, it would be interesting to analyse the activating criteria that lead to using this unusual protocol. Thus, this review aimed to identify indications for a WBB and the common risk mitigation measures. MATERIAL AND METHODS This PRISMA-compliant review only included studies published from 1985 to 25(th) of January 2023 that describe adult male military casualties requiring blood transfused locally using a walking blood transfusion protocol. All relevant data (i.e., activation and contextual factors and risk mitigation measures) were tabulated to retrieve information from the selected military studies. RESULTS Our results indicated that activation criteria were homogeneous across the 12 reviewed studies. Whole blood was collected from a WBB when there was a shortage of blood products and when platelets were needed. In the literature reviewed, the main risks associated with such a protocol, namely hemolytic adverse events and transfusion transmitted diseases, are mitigated by the use of typing and screening measures if they are reported. However, there is less consistency in the implementation of those risk mitigation measures. DISCUSSION This unusual protocol needs to be integrated into the medical support plan until conventional transfusion support can take over, and should include on-site blood collection from a donor, whether a WBB or an emergency donor panel. The benefits of such a protocol outweigh the risks in a life-threatening situation, especially since these risks can be anticipated and minimised by planning to pre-screen all potential donors before their deployment. Finally, educating and training the staff who must implement this unusual procedure can also improve the safety and survival rate of future patients.
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2.
Prehospital hemorrhage management in low- and middle-income countries: A scoping review
Kulkarni, A. J., Batra, A., Eisner, Z. J., Delaney, P. G., Pine, H., Klapow, M. C., Raghavendran, K.
World journal of surgery. 2024
Abstract
INTRODUCTION Low- and middle-income countries (LMICs) account for 90% of deaths due to injury, largely due to hemorrhage. The increased hemorrhage mortality burden in LMICs is exacerbated by absent or ineffective prehospital care. Hemorrhage management (HM) is an essential component of prehospital care in LMICs, yet current practices for prehospital HM and outcomes from first responder HM training have yet to be summarized. METHODS This review describes the current literature on prehospital HM and the impact of first responder HM training in LMICs. Articles published between January 2000 and January 2023 were identified using PMC, MEDLINE, and Scopus databases following PRISMA-ScR guidelines. Inclusion criteria spanned first responder training programs delivering prehospital care for HM. Relevant articles were assessed for quality using the Newcastle-Ottawa scale. RESULTS Of the initial 994 articles, 20 met inclusion criteria representing 16 countries. Studies included randomized control trials, cohort studies, case control studies, reviews, and epidemiological studies. Basic HM curricula were found in 15 studies and advanced HM curricula were found in six studies. Traumatic hemorrhage was indicated in 17 studies while obstetric hemorrhage was indicated in three studies. First responders indicated HM use in 55%-76% of encounters, the most frequent skill they reported using. Mean improvements in HM knowledge acquisition post-course ranged from 23 to 58 percentage points following training for pressure and elevation, gauze application, and tourniquet application. CONCLUSIONS Our study summarizes the current literature on prehospital HM in LMICs pertaining to epidemiology, interventions, and outcomes. HM resources should be a priority for further development.
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3.
Effect of Early Equal-Proportional Infusion of Plasma and Red Blood Cells on the Prognosis of Emergency Patients with Traumatic Hemorrhage
Fan, Y., Ye, Z., Tang, Y.
Clinical laboratory. 2023;69(7)
Abstract
BACKGROUND The goal was to study the effect of early equal-proportion transfusion on the prognosis of trauma patients with bleeding. METHODS Emergency hospital trauma patients were randomly divided into two groups, a group based on assessment of blood consumption (ABC) to assess whether need to start the massive blood transfusion patients, such as proportion of blood transfusion (fresh frozen plasma: suspended red blood cells = 1:1), and the other group using traditional methods of blood transfusion, namely according to routine blood and clotting function and hemodynamic parameters, to decide when and what blood constituents should be transfused. RESULTS The coagulation got better in the early equal-proportion transfusion group, there were significant differences of PT and APTT (p < 0.05). The amount of 24 hours RBC and plasma transfusion was decreased in the early equal-proportion transfusion group, compared to the control group (p < 0.05), the length of ICU stay was shortened, the 24-hours SOFA score was improved, and there was no significant difference in 24-hours mortality, in-hospital mortality and total length of in-hospital stay (p > 0.05). CONCLUSIONS Early transfusion can reduce the total amount of blood transfusion and shorten ICU time, but has no significant effect on mortality.
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4.
Study on the Effectiveness and Value of Evidence-Based Nursing and Predictive Nursing in Emergency Treatment of Upper Gastrointestinal Bleeding
Yang, Y., Li, Z., He, Y., Xu, M.
Alternative therapies in health and medicine. 2023
Abstract
OBJECTIVE To study the effectiveness and value of evidence-based nursing and predictive nursing in emergency treatment of upper gastrointestinal bleeding. METHODS A total of 100 patients with upper gastrointestinal bleeding in our hospital were selected. The period was from January 2020 to June 2022. They were grouped according to the double color ball method, 50 cases in the control group were given routine nursing, and 50 cases in the observation group were given evidence-based nursing combined with predictive nursing. The key points of evidence-based nursing are to identify the evidence-based question, search for relevant literature, identify scientifically effective nursing measures, and develop nursing care plans that are tailored to the patient's specific situation based on evidence and clinical experience. Predictive nursing requires nurses to have a high level of awareness and risk prevention consciousness to provide care for early signs of bleeding and prevent the occurrence of complications. The psychological state scores, clinical-related indicators, clinical efficacy, incidence of complications, nursing satisfaction, and quality of life scores of the two groups were compared. RESULTS After the intervention, the SAS score (42.25 ± 1.67) and SDS score (43.59 ± 1.86) of the observation group were lower than those of the control group, the bleeding times (2.41 ± 0.45) of the observation group were less than those of the control group, the hemostasis time (30.12 ± 5.38d) and hospitalization time (5.01 ± 1.11d) of the observation group were shorter than those of the control group, and the difference was statistically significant (all P < .05). The total effective rate of hemostasis (96.00%), patient satisfaction (98.00%), and scores of physical health (88.98 ± 5.59), psychological function (91.08 ± 5.11), material life state (90.54 ± 6.46) and social function (89.59 ± 5.78) in GQOLI-74 scores in the observation group were higher than those in the control group. The incidence of complications (6.00%) in the observation group was lower than that in the control group, and the difference was statistically significant (all P < .05). CONCLUSION Upper gastrointestinal bleeding is a common emergency in gastroenterology, characterized by rapid onset, severe symptoms, and quick changes. Therefore, in order to expedite the recovery of patients with acute upper gastrointestinal bleeding and ensure their safety, it is necessary to provide effective clinical emergency nursing care. Evidence-based nursing can help nurses take appropriate nursing measures based on the best and latest evidence, to meet the reasonable individualized needs of patients. Predictive nursing is a nursing model that predicts potential nursing risks in advance and takes corresponding preventive measures. It can timely and systematically address risks in nursing and promote improvements in the effectiveness of disease treatment. The combined application of evidence-based nursing and predictive nursing can improve the hemostatic efficiency of patients with upper gastrointestinal bleeding, improve the psychological state and quality of life, reduce the incidence of complications, and obtain higher satisfaction. The combined application of these two nursing models has positive implications for improving nursing efficiency, enhancing patient cooperation during emergency care, improving hemostasis effectiveness, enhancing quality of life, and fostering a harmonious nurse-patient relationship.
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5.
The Impact of a Humanized Nursing Model on the Nursing Outcomes of Emergency Transfusion Patients
Chen, J., Ding, D.
Alternative therapies in health and medicine. 2023
Abstract
BACKGROUND Emergency transfusion is a frequently performed invasive medical procedure. Patients often experience negative emotions and exhibit poor compliance during transfusion. Therefore, it is imperative to proactively implement effective nursing interventions. OBJECTIVE This study aims to investigate the impact of a humanized nursing model on the nursing outcomes of emergency transfusion patients. DESIGN This research was conducted as a randomized controlled experiment. SETTING The study was conducted in the emergency department of Suzhou Hospital of Integrated Chinese and Western Medicine. PARTICIPANTS A total of 120 patients who underwent emergency transfusion treatment in our hospital from February 2021 to October 2022 were selected. They were divided into two groups, the control group, and the observation group, using a random number table method, with 60 patients in each group. INTERVENTIONS The control group received standard nursing care, while the observation group received humanized nursing. PRIMARY OUTCOME MEASURES The primary outcome measures included (1) assessment of psychological states, (2) evaluation of physical and mental comfort, (3) assessment of transfusion compliance, (4) incidence of adverse transfusion events, and (5) assessment of nursing satisfaction. RESULTS Prior to nursing interventions, anxiety and depression scores were not significantly different between the two groups (P > .05). After nursing interventions, both groups exhibited a decrease in scores, with the observation group showing a more significant reduction compared to the control group (P < .05). In all aspects of physical and mental comfort, the observation group scored significantly higher than the control group (P < .05). Transfusion compliance and nursing satisfaction were significantly higher in the observation group compared to the control group (P < .01). The incidence of adverse transfusion events in the observation group was significantly lower than in the control group (P < .01). CONCLUSIONS Humanized nursing significantly improves anxiety and depression in emergency transfusion patients, enhances their physical and mental comfort, and increases transfusion compliance while reducing adverse transfusion events. It leads to high patient satisfaction with nursing services.
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6.
Small-Volume Blood Collection Tubes to Reduce Transfusions in Intensive Care: The STRATUS Randomized Clinical Trial
Siegal, D. M., Belley-Côté, E. P., Lee, S. F., Hill, S., D'Aragon, F., Zarychanski, R., Rochwerg, B., Chassé, M., Binnie, A., Honarmand, K., et al
Jama. 2023
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Editor's Choice
Abstract
IMPORTANCE Blood collection for laboratory testing in intensive care unit (ICU) patients is a modifiable contributor to anemia and red blood cell (RBC) transfusion. Most blood withdrawn is not required for analysis and is discarded. OBJECTIVE To determine whether transitioning from standard-volume to small-volume vacuum tubes for blood collection in ICUs reduces RBC transfusion without compromising laboratory testing procedures. DESIGN, SETTING, AND PARTICIPANTS Stepped-wedge cluster randomized trial in 25 adult medical-surgical ICUs in Canada (February 5, 2019 to January21, 2021). INTERVENTIONS ICUs were randomized to transition from standard-volume (n = 10 940) to small-volume tubes (n = 10 261) for laboratory testing. MAIN OUTCOMES AND MEASURES The primary outcome was RBC transfusion (units per patient per ICU stay). Secondary outcomes were patients receiving at least 1 RBC transfusion, hemoglobin decrease during ICU stay (adjusted for RBC transfusion), specimens with insufficient volume for testing, length of stay in the ICU and hospital, and mortality in the ICU and hospital. The primary analysis included patients admitted for 48 hours or more, excluding those admitted during a 5.5-month COVID-19-related trial hiatus. RESULTS In the primary analysis of 21 201 patients (mean age, 63.5 years; 39.9% female), which excluded 6210 patients admitted during the early COVID-19 pandemic, there was no significant difference in RBC units per patient per ICU stay (relative risk [RR], 0.91 [95% CI, 0.79 to 1.05]; P = .19; absolute reduction of 7.24 RBC units/100 patients per ICU stay [95% CI, -3.28 to 19.44]). In a prespecified secondary analysis (n = 27 411 patients), RBC units per patient per ICU stay decreased after transition from standard-volume to small-volume tubes (RR, 0.88 [95% CI, 0.77 to 1.00]; P = .04; absolute reduction of 9.84 RBC units/100 patients per ICU stay [95% CI, 0.24 to 20.76]). Median decrease in transfusion-adjusted hemoglobin was not statistically different in the primary population (mean difference, 0.10 g/dL [95% CI, -0.04 to 0.23]) and lower in the secondary population (mean difference, 0.17 g/dL [95% CI, 0.05 to 0.29]). Specimens with insufficient quantity for analysis were rare (≤0.03%) before and after transition. CONCLUSIONS AND RELEVANCE Use of small-volume blood collection tubes in the ICU may decrease RBC transfusions without affecting laboratory analysis. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03578419.
PICO Summary
Population
Adult patients in 25 medical-surgical intensive care units (ICU) in Canada (n= 21,201).
Intervention
Small-volume vacuum tubes for blood collection (n= 10,261).
Comparison
Standard-volume vacuum tubes for blood collection (n= 10,940).
Outcome
In the primary analysis of 21,201 patients, which excluded 6,210 patients admitted during the early COVID-19 pandemic, there was no significant difference in red blood cell (RBC) units per patient per ICU stay (relative risk [RR] 0.91; 95% CI [0.79, 1.05]; absolute reduction of 7.24 RBC units/100 patients per ICU stay 95% CI [-3.28, 19.44]). In a prespecified secondary analysis (n= 27,411 patients), RBC units per patient per ICU stay decreased after transition from standard-volume to small-volume tubes (RR 0.88; 95% CI [0.77, 1.00]; absolute reduction of 9.84 RBC units/100 patients per ICU stay 95% CI [0.24, 20.76]). Median decrease in transfusion-adjusted haemoglobin was not statistically different in the primary population (mean difference 0.10 g/dL; 95% CI [-0.04, 0.23]) and lower in the secondary population (mean difference 0.17 g/dL; 95% CI [0.05, 0.29]). Specimens with insufficient quantity for analysis were rare (≤0.03%) before and after transition.
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7.
Trial-related blood sampling and red-blood-cell transfusions in preterm infants
Lewis, A. E., Kappel, S. S., Hussain, S., Sangild, P. T., Zachariassen, G., Aunsholt, L.
Acta paediatrica (Oslo, Norway : 1992). 2023
Abstract
AIM: To determine if trial-related blood sampling increases the risk of later red-blood-cell (RBC) transfusion in very preterm infants, we compared the volume of clinical- and trial-related blood samples, in a specific trial and correlated to subsequent RBC transfusion. METHODS For 193 very preterm infants, participating in the FortiColos trial (NCT03537365), trial-related blood volume drawn was in accordance to ethical considerations established by the European Commission. Medical records were reviewed to assess the number and cumulated volume (mL/kg) of blood samples (both clinical- and trial-related). Data were compared with need of RBC transfusions during the first 28days of life. RESULTS Mean (SD) gestational age and bith weight was 28 ± 1 weeks and 1168 ± 301 g. In total, 11% of total blood volume was drawn for sampling (8.1 ± 5.1 mL/kg) and trial-related sampling accounted for 1.6 ± 0.6 mL/kg. Trial-related blood sampling had no impact on RBC transfusion (p=0.9). CONCLUSION Clinical blood sampling in very preterm infants is associated with blood loss and subsequent need for RBC transfusions. In a specific trial requiring blood samples, we found no additional burden of trial-related blood sampling. The study suggest that trial-related sampling is safe if European criteria are followed.
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8.
Assessment of Hemostatic Profile in Neonates with Intrauterine Growth Restriction: A Systematic Review of Literature
Karapati E, Sokou R, Iliodromiti Z, Tsaousi M, Sulaj A, Tsantes AG, Petropoulou C, Pouliakis A, Tsantes AE, Boutsikou T, et al
Seminars in thrombosis and hemostasis. 2023
Abstract
Intrauterine growth restriction (IUGR) affects nearly 10 to 15% of pregnancies and is responsible for many short- and long-term adverse consequences, including hemostatic derangement. Both thrombotic and hemorrhagic events are described in the perinatal period in these neonates. The aim of this study was to systematically review the literature on the laboratory studies used to evaluate the hemostatic system of the IUGR small for gestational age neonate. We reviewed the current literature via PubMed and Scopus until September 2022. Following our inclusion/exclusion criteria, we finally included 60 studies in our review. Thrombocytopenia, characterized as hyporegenerative and a kinetic upshot of reduced platelet production due to in utero chronic hypoxia, was the main finding of most studies focusing on growth-restricted neonates, in most cases is mild and usually resolves spontaneously with the first 2 weeks of life. In regard to coagulation, growth-restricted newborns present with prolonged standard coagulation tests. Data regarding coagulation factors, fibrinolytic system, and anticoagulant proteins are scarce and conflicting, mainly due to confounding factors. As thromboelastography/rotational thromboelastometry (TEG/ROTEM) provides a more precise evaluation of the in vivo coagulation process compared with standard coagulation tests, its use in transfusion guidance is fundamental. Only one study regarding TEG/ROTEM was retrieved from this population, where no difference in ROTEM parameters compared with appropriate for gestational age neonates was found. Despite the laboratory aberrations, no correlation could be achieved with clinical manifestations of bleeding or thrombosis in the studies included. More studies are needed to assess hemostasis in IUGR neonates and guide targeted therapeutic interventions.
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9.
Detection of Acute Traumatic Coagulopathy by Viscoelastic Haemostatic Assays Compared to Standard Laboratory Tests: A Systematic Review
Forster, E. K., Hendel, S., Mitra, B.
Transfusion medicine and hemotherapy : offizielles Organ der Deutschen Gesellschaft fur Transfusionsmedizin und Immunhamatologie. 2023;50(4):334-347
Abstract
INTRODUCTION The aim of this systematic review was to investigate whether viscoelastic haemostatic assays (VHAs) offer comparative diagnostic ability of acute traumatic coagulopathy (ATC) compared to the standard laboratory coagulation tests (SLCT). ATC is a complication of major trauma characterized by dysfunctional blood clotting, leading to an increased bleeding risk. Additionally, we aimed to analyse the association of VHA with blood product use and health outcomes. METHODS The search protocol was pre-published and completed on December 2, 2020, assessing manuscripts from 2000 until the present. We searched MEDLINE, Embase, Cochrane Central, BIOSIS, Emcare, CINAHL, and additional online resources and referenced lists. Included were manuscripts that quantitatively reported the detection of ATC using VHAs and SLCTs. A meta-analysis was undertaken including observational studies that reported on patients with injuries to all body regions and results analysed using a random-effects model and reported using pooled odds ratio with 95% confidence intervals (CI). RESULTS There were 14 observational studies and one randomized control trial involving 2,715 participants that satisfied inclusion criteria. We observed significant heterogeneity in the definitions of ATC, study design, setting, and patient population. Among observational studies that reported on patients with injuries to all body regions, VHAs were associated with higher odds of diagnosing ATC compared to SLCT (pooled OR 2.4; 95% CI: 1.4-4.1). There was inadequate evidence to suggest VHAs were associated with reduced blood product usage or lower mortality. CONCLUSION VHAs detected more patients with ATC compared to SLCTs. However, the clinical significance and applicability of this finding remains unknown as translation to management was not adequately reported.
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10.
Comparison of anticoagulation monitoring strategies for adults supported on extracorporeal membrane oxygenation: A systematic review
Sun J, Ma Y, Su W, Miao H, Guo Z, Chen Q, Zhang Y, Ma X, Chen S, Ding R
Heart & lung : the journal of critical care. 2023;61:72-83
Abstract
BACKGROUND Anticoagulation is critical in patients supported on extracorporeal membrane oxygenation (ECMO). The appropriate monitoring strategies for heparin remain unclear. OBJECTIVES This systematic review aimed to compare the accuracy and safety of various monitoring strategies for patients supported on ECMO. METHODS The PubMed and Web of Science databases were searched for articles in March 2023 without restrictions on publication date. Anticoagulation monitoring strategies for adults supported on ECMO were compared across all included studies. The incidence of bleeding, thrombosis, mortality, blood transfusion, correlation between tests and heparin dose, and the discordance between different tests were discussed in the included studies. The risk of bias was assessed using the Newcastle-Ottawa Scale and Cochrane Collaboration's tool. RESULTS Twenty-six studies, including a total of 1,684 patients, met the inclusion criteria. The monitoring of anticoagulation by activated partial thromboplastin time (aPTT) resulted in less blood product transfusion than that by activated clotting time (ACT). Moreover, the monitoring of anticoagulation by anti-factor Xa (Anti-Xa) resulted in a more stable anticoagulation than that by aPTT. Anti-Xa and aPTT correlated with heparin dose better than ACT, and the discordance between different monitoring tests was common. Finally, combined monitoring showed some advantages in reducing mortality and blood product transfusion. CONCLUSION Anti-Xa and aPTT are more suitable for anticoagulation monitoring for patients supported on ECMO than ACT. Thromboelastography and combination strategies are less applied. Most of the studies were retrospective, and their sample sizes were relatively small; thus, more appropriate monitoring strategies and higher quality research are needed.