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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.
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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3.
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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4.
Predictive value of tachycardia for mortality in trauma-related haemorrhagic shock: a systematic review and meta-regression
Jávor, P., Hanák, L., Hegyi, P., Csonka, E., Butt, E., Horváth, T., Góg, I., Lukacs, A., Soós, A., Rumbus, Z., et al
BMJ open. 2022;12(10):e059271
Abstract
OBJECTIVES Heart rate (HR) is one of the physiological variables in the early assessment of trauma-related haemorrhagic shock, according to Advanced Trauma Life Support (ATLS). However, its efficiency as predictor of mortality is contradicted by several studies. Furthermore, the linear association between HR and the severity of shock and blood loss presented by ATLS is doubtful. This systematic review aims to update current knowledge on the role of HR in the initial haemodynamic assessment of patients who had a trauma. DESIGN This study is a systematic review and meta-regression that follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. DATA SOURCES EMBASE, MEDLINE, CENTRAL and Web of Science databases were systematically searched through on 1 September 2020. ELIGIBILITY CRITERIA Papers providing early HR and mortality data on bleeding patients who had a trauma were included. Patient cohorts were considered haemorrhagic if the inclusion criteria of the studies contained transfusion and/or positive focused assessment with sonography for trauma and/or postinjury haemodynamical instability and/or abdominal gunshot injury. Studies on burns, traumatic spinal or brain injuries were excluded. Papers published before January 2010 were not considered. DATA EXTRACTION AND SYNTHESIS Data extraction and risk of bias were assessed by two independent investigators. The association between HR and mortality of patients who had a trauma was assessed using meta-regression analysis. As subgroup analysis, meta-regression was performed on patients who received blood products. RESULTS From a total of 2017 papers, 19 studies met our eligibility criteria. Our primary meta-regression did not find a significant relation (p=0.847) between HR and mortality in patients who had a trauma with haemorrhage. Our subgroup analysis included 10 studies, and it could not reveal a linear association between HR and mortality rate. CONCLUSIONS In accordance with the literature demonstrating the multiphasic response of HR to bleeding, our study presents the lack of linear association between postinjury HR and mortality. Modifying the pattern of HR derangements in the ATLS shock classification may result in a more precise teaching tool for young clinicians.
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5.
Coagulation in pediatric extracorporeal membrane oxygenation: A systematic review of studies shows lack of standardized reporting
Drop J, Van Den Helm S, Monagle P, Wildschut E, de Hoog M, Gunput STG, Newall F, Dalton HJ, MacLaren G, Ignjatovic V, et al
Research and practice in thrombosis and haemostasis. 2022;6(2):e12687
Abstract
OBJECTIVES Extracorporeal membrane oxygenation (ECMO) involves complex coagulation management and frequent hemostatic complications. ECMO practice between centers is variable. To compare results between coagulation studies, standardized definitions and clear documentation of ECMO practice is essential. We assessed how study population, outcome definitions, and ECMO-, coagulation-, and transfusion-related parameters were described in pediatric ECMO studies. DATA SOURCES Embase, Medline, Web of Science, Cochrane Library and Google Scholar. STUDY SELECTION English original studies of pediatric ECMO patients describing hemostatic tests or outcome. DATA EXTRACTION Eligibility was assessed following PRISMA guidelines. Study population, outcome and ECMO-, coagulation, and transfusion parameters were summarized. DATA SYNTHESIS A total of 107 of 1312 records were included. Study population parameters most frequently included (gestational) age (79%), gender (60%), and (birth) weight (59%). Outcomes, including definitions of bleeding (29%), thrombosis (15%), and survival (43%), were described using various definitions. Description of pump type, oxygenator and cannulation mode occurred in 49%, 45%, and 36% of studies, respectively. The main coagulation test (53%), its reference ranges (49%), and frequency of testing (24%) were the most prevalent reported coagulation parameters. The transfusion thresholds for platelets, red blood cells, and fibrinogen were described in 27%, 18%, and 18% of studies, respectively. CONCLUSIONS This systematic review demonstrates a widespread lack of detail or standardization of several parameters in coagulation research of pediatric ECMO patients. We suggest several parameters that might be included in future coagulation studies. We encourage the ECMO community to adopt and refine this list of parameters and to use standardized definitions in future research.
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6.
Metrics of shock in pediatric trauma patients: A systematic search and review
Alberto, E. C., McKenna, E., Amberson, M. J., Tashiro, J., Donnelly, K., Thenappan, A. A., Tempel, P. E., Ranganna, A. S., Keller, S., Marsic, I., et al
Injury. 2021;52(10):3166-3172
Abstract
INTRODUCTION Shock-index (SI) and systolic blood pressure (SBP) are metrics for identifying children and adults with hemodynamic instability following injury. The purpose of this systematic review was to assess the quality of these metrics as predictors of outcomes following pediatric injury. MATERIALS AND METHODS We conducted a literature search in Pubmed, SCOPUS, and CINAHL to identify studies describing the association between shock metrics on the morbidity and mortality of injured children and adolescents. We used the data presented in the studies to calculate the sensitivity and specificity for each metric. This study was registered with Prospero, protocol CRD42020162971. RESULTS Fifteen articles met the inclusion criteria. seven studies evaluated SI or SIPA score, an age-corrected version of SI, as predictors of outcomes following pediatric trauma, with one study comparing SIPA score and SBP and one study comparing SI and SBP. The remaining eight studies evaluated SBP as the primary indicator of shock. The median sensitivity for predicting mortality and need for blood transfusion was highest for SI, followed by SIPA, and then SBP. The median specificity for predicting these outcomes was highest for SBP, followed by SIPA, and then SI. CONCLUSIONS Common conclusions were that high SIPA scores were more specific than SI and more sensitive than SBP. SIPA score had better discrimination for severely injured children compared to SI and SBP. An elevated SIPA was associated with a greater need for blood transfusion and higher in-hospital mortality. SIPA is specific enough to exclude most patients who do not require a blood transfusion.
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7.
Challenges in Maintaining the Hemostatic Balance in Children Undergoing Extracorporeal Membrane Oxygenation: A Systematic Literature Review
Drop JGF, Wildschut ED, Gunput STG, de Hoog M, van Ommen CH
Frontiers in pediatrics. 2020;8:612467
Abstract
Background: Despite advances in technology and clinical experience, the incidence of hemostatic complications, including bleeding and thrombosis, remains high in children supported with extracorporeal membrane oxygenation (ECMO). These hemostatic complications are important to prevent, since they are associated with increased morbidity and mortality. This systematic literature review aims to outline the most important risk factors for hemostatic complications in children undergoing ECMO treatment, to summarize the reported alternative anticoagulant drugs used in pediatric ECMO and to describe studied associations between coagulation tests and hemostatic complications. Methods: A literature search was performed in Embase, Medline, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, and Google Scholar in February 2020. Included studies were studies evaluating children (<18 years old) treated with ECMO, and studies evaluating risk factors for hemostatic complications, alternative anticoagulants, or the association between coagulation tests and hemostatic complications. Results: Out of 1,152 articles, 35 studies were included. Thirteen out of 49 risk factors were investigated in three or more studies. Most consistent results were found regarding ECMO duration and pH. However, evidence for risk factors was equivocal in the majority of studies, which is explained by the variability of populations studied, definitions of hemostatic complications, ECMO circuits, anticoagulation protocols, transfusion triggers and monitoring of anticoagulation. Five studies described alternative anticoagulants, including bivalirudin (n = 3), argatroban (n = 1) and FUT (n = 1). Higher anti-factor Xa levels were associated with less clotting events in one of nine studies, investigating the association between tests and hemostatic complications. Two studies revealed an association between anti-factor Xa assay-based protocols and a decreased number of transfusions, bleedings and need for circuit change. Conclusion: Studies regarding risk factors showed conflicting results and a few retrospective studies reported the use of new anticoagulants and data on coagulation tests in relation to hemostatic complications. To decrease hemostatic complications in ECMO children, prospective multicenter studies are needed with clear bleeding and thrombotic definitions, and the best possible standardization of ECMO circuits used, anticoagulation protocols, and transfusion triggers.