Massive transfusion protocol.

The management of severe traumatic bleeding includes damage control resuscitation procedures including, in addition to surgical bleeding control, the application of the massive transfusion protocol. The aim of this paper is to present the massive transfusion protocol and selected scoring systems for an early detection of patients with severe post-traumatic bleeding. The use of a standardized protocol to activate the massive transfusion protocol reduces lethality due to severe traumatic bleeding and the consumption of blood products in trauma centers.

[Effect of COVID-19 Pandemic on Major Trauma Treated at a Level I Trauma Centre]. / Vliv pandemie Covid-19 na závazné úrazy osetrované v traumacentru I. typu.

PURPOSE OF THE STUDY The paper aims to evaluate the effect of COVID-19 pandemic on a change in the number of major trauma cases, their mechanism and length of hospital stay as seen by a Level I Trauma Centre. MATERIAL AND METHODS The retrospective study included a total of 755 major trauma patients (ISS ≥ 16) treated at our Level I Trauma Centre in the period 2018-2019 ("pre-COVID-19 time") and 2020-2021 ("COVID-19 time"). The effect of COVID-19 infection on the change in the number and nature of major trauma, mechanism of injury, length of treatment during prehospital care, length of hospital stay, and mortality. RESULTS Of the total number of 755 patients with major trauma, in the "pre-COVID-19 time" 399 patients were treated, while in the "COVID-19 time" it was 356 patients (p = 0.10). The mechanism of major trauma did not change, road traffic accidents prevailed (61% vs. 56%, p = 0.25), the proportion of injuries due to falls from height increased (25% vs. 32.5%, p = 0.08), a significant decrease was observed in the category of severe skiing injuries (7 vs. 2, p = 0.003). The severity of injuries evaluated by Injury Severity Score remained unchanged (25 vs. 25, p = 0.08), but an increased number of patients with traumatic brain injury (TBI) marked by the Abbreviate Injury Score (AIS) ≥ 4 was observed (38 vs. 56, p = 0.03). The total length of a hospital stay shortened (18 vs. 15 days, p = 0.04), but the mortality rate spiked (52 vs. 73 patients, p = 0.08). DISCUSSION In the "COVID-19 time", the total number of major trauma cases dropped just like in the other European countries. Despite restrictive measures imposing mobility restrictions, no change was reported in the mechanism of injury, with traffic accidents still prevalent, except for skiing injuries. Unlike the US, we did not see an increase in penetrating injuries due to interpersonal violence or suicidal behaviour. However, there was an increase in the percentage of patients with an isolated TBI as a result of a fall from height. An increase in mortality was reported due to an increase in severe TBI. The length of hospital stay was reduced as a result of efforts to maintain hospital bed availability. CONCLUSIONS During the COVID-19 pandemic, compared to the two years immediately preceding, no significant decrease in the number of major trauma cases was reported, despite the introduction of restrictive measures. The proportion of road traffic injuries remained the same, whereas the number of falls from height slightly increased, which consequently led to an increase in the number of severe TBI. The number of penetrating injuries due to acts of violence did not increase, but due to the lockdown there was a significant decrease in severe skiing-related injuries. The anti-epidemic measures in place did not prolong the pre-hospital care for severely injured patients. Key words: major trauma, Injury Severity Score, COVID-19, mechanism of injury.

Prehospital blood and blood products administration.

The history of blood administration in injured patients in the prehospital care started early after the discovery of blood groups in the first decade of the 20th century. The first practical experiences were gained by army during World War I. During the 20th century blood products were not admini-stered in the civilian prehospital care due to the risk of infectious disease transmission, transfusion reactions and donor deficiency. A rebirth of this method was seen at the beginning of the 21st century when the concept of remote damage control resuscitation was defined and blood became a part of hemostatic resuscitation. Different countries may use different blood products (whole blood, erythrocytes, plasma, fibrinogen, etc.) in prehospital treatment of a severely bleeding patient. Prehospital blood administration is feasible and safe. However, what is the most beneficial blood product for a patient with severe hemorrhagic-traumatic shock during the prehospital phase? This question is now explored in ongoing studies. This paper provides an overview of current policies for pre-hospital blood products administration.