Effect of Haemostatic Control Resuscitation on mortality in massively bleeding patients: a before and after study.

ABSTRACT

BACKGROUND AND OBJECTIVES: Evidence supporting the use of platelets and plasma in resuscitation of massive bleedings is questionable. Current consensus guidelines recommend restrictive use. Our aim was to determine the effect of changing the transfusion practice on 30-day survival in massively bleeding patients. MATERIALS AND METHODS: Consecutive adult patients receiving more than 10 units of red blood cells (RBC) within 24 h 2 years prior to (2002-2003) and 2 years after (2005-2006) a change in transfusion practice were included. In 2004, we implemented Haemostatic Control Resuscitation (HCR) with preemptive use of platelets and plasma, administered in transfusion packages, comprising 5 units of RBCs, 5 units of fresh-frozen plasma and 2 units of platelet concentrates (PC), when massive bleeding occurred or upon arrival at the emergency room and thereafter directed by thrombelastography throughout the peri- and postoperative period. RESULTS: In 2005-2006, the 442 patients received more PCs within 24 h from admission [mean 5.0 (SD 4.2) vs. 1.7 (2.0); P < 0.0001] and had a smaller decrease in platelet count during the bleeding episode [91.5 (81.2) vs. 119.7 (100.8) x 10(9)/l; P = 0.0025] than the 390 patients treated in 2002-2003. Thirty-day mortality was reduced in 2005-2006 (20.4% vs. 31.5%; P = 0.0002) and at 90-day (22.4% vs. 34.6%; P < 0.0001) as compared to 2002-2003. CONCLUSIONS: In patients who experience massive bleeding, HCR with platelets and plasma, as guided by thrombelastography, is associated with improved survival. While confirmation from a randomized controlled trial is urgently needed, HCR may be considered in these patients.