Implementation and evaluation of a major haemorrhage protocol in the Emergency Department Resuscitation Area in the University-affiliated Hospital of Brest (France).

Haemorrhagic shock is a rare occurrence in emergency medicine but it can be associated with significant mortality. The purpose of this study was to evaluate the impact of a major haemorrhage protocol on patient management in Emergency Department Resuscitation Area. METHODS: A single-centre study was conducted to compare two periods, before and after institution of a massive haemorrhage protocol including the use of massive transfusion orders and the availability of packed red blood cell concentrates prior to patient's admission. Two groups of patients (in both trauma and non-trauma settings) were defined: "before protocol" and "after protocol". The primary outcome was the median transfusion time for a unit of red blood cell concentrate. RESULTS: Forty patients were included: 22 for the "pre-protocol" group and 18 for the "post-protocol" group. The two groups were balanced with baseline characteristics. This study showed a significantly reduced median transfusion time for a unit of red blood cell concentrate from 20min pre-protocol to 9min post-protocol. The time between patient's admission and transfusion of the first red blood cell concentrate was reduced but non-significantly from 71min to 36min. CONCLUSION: The major haemorrhage protocol optimised patient management by reducing the median transfusion time for red blood cell concentrates.

[Transfusion-transmitted bacterial infection of a apheresis platelet concentrate with Streptococcus gallolyticus: Analysis of one case]. / Infection bactérienne à Streptococcus gallolyticus transmise par transfusion d'un concentré de plaquettes : à propos d'un cas.

Bacterial infections are uncommon complications of the blood products transfusion but they are potentially serious. Many advances have been done over the past few years to guarantee the microbiological security of blood products as the donors selection with a medical talk, the derivation of the first 30 millilitres blood during the donation, the deleucocytation of blood products… But in spite of these advances, cases of bacterial infection always remain. The purpose of this study was to point out the platelet concentrate's transfusion-transmitted bacterial infection with Streptococcus gallolyticus and the unusual consequence for the donor by uncovering an asymptomatic rectal neoplastic tumor. This study as raised as to whether the usefulness of systematic bacterial inactivation in the platelets concentrates.

[A quality program in haemovigilance: evaluation of the blood transfusion chain]. / Démarche qualité en hémovigilance: analyse du processus transfusionnel.

Blood transfusion, like any effective therapy, involves an element of risk. In order to reduce such risks to a maximum, a legislative and statutory framework has been set up. A reliable evaluation of this system is necessary together with an efficient evaluation method whose aim is to guarantee quality service. Favouring the development of the evaluation of professional practices is one of the priorities of the National Agency of Accreditation and Evaluation in Health (ANAES) created in April 1996. Following the recommendations from ANAES, the University Hospital of Brest decided to set up an evaluation of blood transfusion chain from the prescription of blood products to the transfusion act and follow-up of receivers in two health care services. The method used for this evaluation was a clinical audit. It is a method of evaluation, which allows with the help of certain criteria, care practices to be compared to accepted references, in order to measure the quality of these practices and the results of hospital care, so that improvements may be added. We present here the method and results of this evaluation, as well as the improvements we have put in place.

[Imported malaria in Brest hospitals from 1981 to 1990]. / Le paludisme d'importation dans les hôpitaux de Brest de 1981 a 1990.

From 1981 to 1990, 96 confirmed hospital cases of imported malaria occurred in Brest. An important increasing of the annual number was observed in 1986. A high proportion of infection was due to Plasmodium falciparum, mainly from black Africa. Most of the patients was French young men, without or with inadequate chemoprophylaxis. Every case of malaria due to P. falciparum appeared during the 2 months following their return from an endemic area. Two patients had a clinical profile of visceral evolutive malaria and 5 a cerebral malaria. Three patients died.