Massive Transfusion Protocols in Non-Trauma Patients: A Systematic Review and Meta-Analysis

Background Massive bleeding is a major cause of death both in trauma and non-trauma patients. In trauma patients, the implementation of massive transfusion protocols (MTP) led to improved outcomes. However, the majority of patients with massive bleeding are non-trauma patients. Objectives To assess if the implementation MTP in non-trauma patients with massive bleeding leads to improved survival. Data sources National Library of Medicine’s Medline database (PubMed). Study eligibility criteria Original research articles in English language investigating MTP in non-trauma patients. Participants Non-trauma patients with massive bleeding ≥ 18 years of age. Intervention Transfusion according to MTP versus off-protocol. Study appraisal and synthesis methods Systematic literature review using PubMed. Outcomes assessed were mortality and transfused blood products. Studies that compared mortality of MTP and non-MTP groups were included in meta-analysis using Mantel-Haenszel random effect models. Results A total of 252 abstracts were screened. Of these, 12 studies published 2007-2017 were found to be relevant to the topic, including 2,475 patients. All studies were retrospective and comprised different patient populations. Most frequent indications for massive transfusion were perioperative, obstetrical and gastrointestinal bleeding, as well as vascular emergencies. Four out of the five studies that compared the number of transfused blood products in MTP and non-MTP groups revealed no significant difference. Meta-analysis revealed no sigificant effect of MTP on the 24-hour mortality (OR 0.42, 95%CI 0.01-16.62, p=0.65) and a trend towards lower one-month mortality (OR 0.56, 95%CI 0.30-1.07, p=0.08). Limitations Heterogeneous patient populations and MTP in the studies included. Conclusions and implications of key findings There is limited evidence that the implementation of MTP may be associated with decreased mortality in non-trauma patients. However, patient characteristics, as well as the indication and definition of MTP were highly hetergenous in the available studies. Further prospective investigation into this topic is warranted. Study type Systematic review and meta-analysis Level of evidence Level III Author’s email addresses: Nora Sommer: nora_sommer@bluewin.ch Beat Schnüriger: beat.schnuriger@gmail.com Daniel Candinas: daniel.candinas@insel.ch Tobias Haltmeier: tobias.haltmeier@icloud.com Address of correspondence: Tobias Haltmeier, MD, FACS, Department of Visceral Surgery and Medicine, Division of Acute Care Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland, Phone: +41 31 632 59 00, Fax: +41 31 632 59 99. E-mail: tobias.haltmeier@icloud.com Disclosure: Nora Sommer, Beat Schnüriger, Daniel Candinas, and Tobias Haltmeier have no conflicts of interest or financial ties to disclose. © 2018 Lippincott Williams & Wilkins, Inc.

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