Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2020 Nov;18(6):434-445.
doi: 10.2450/2020.0065-20. Epub 2020 Sep 18.

The effect of massive transfusion protocol implementation on the survival of trauma patients: a systematic review and meta-analysis

Rafael Consunji  1 , Alaa Elseed  1 , Ayman El-Menyar  1   2   3 , Brijesh Sathian  2 , Sandro Rizoli  1 , Hassan Al-Thani  1 , Ruben Peralta  1   4
Affiliations
Meta-Analysis

The effect of massive transfusion protocol implementation on the survival of trauma patients: a systematic review and meta-analysis

Rafael Consunji et al. Blood Transfus. 2020 Nov.

Abstract

Background: Massive transfusion protocol (MTP) has been widely adopted for the care of bleeding trauma patients but its actual effectiveness is unclear. An earlier meta-analysis on the implementation of MTP for injured patients from 1990 to 2013 reported that only 2 out of 8 studies showed statistical improvement in survival. This study aimed to conduct an updated systematic review and meta-analysis to evaluate the effect of implementing an MTP on the mortality of trauma patients.

Materials and methods: MEDLINE, PubMed, Cochrane Library and Google scholar databases were systematically searched for relevant studies published from 1st January 2008 to 30th September 2019 using a combination of keywords and additional manual searching of reference lists. Inclusion criteria were: original study in English, study population including trauma patients, and comparison of mortality outcomes before and after institutional implementation of an MTP. Primary outcomes were 24-hour, 30-day, and overall mortality.

Results: Fourteen studies met inclusion criteria, analysing outcomes from 3,201 trauma patients. There was a wide range of outcomes, patient populations, and process indicators utilised by the different authors. MTP significantly reduced the overall mortality for trauma patients (OR 0.71 [0.56-0.90]). No significant reduction was seen in either the 24-hour mortality (OR 0.81 [0.57-1.14]) or the 30-day mortality (OR 0.73 [0.46-1.16]). However, when mortality timing was unspecified, mortality was statistically reduced (OR 0.69 [0.55-0.86]).

Discussion: The present study found a significant reduction in mortality following MTP implementation and thus it should be recommended to all institutions managing acutely injured patients. To better identify which elements of an MTP contribute to this effect, we encourage the use of standard nomenclature, indicators, protocols and patient populations in all future MTP studies.

PubMed Disclaimer

Conflict of interest statement

The Authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Flow diagram of study selection process for the systematic review and meta-analysis MTP: massive transfusion protocol.
Figure 2
Figure 2
Forest plot representing the effect of massive transfusion protocol (MTP) on mortality (24-hour, 30-day, and overall survivals and unspecific timing)
Figure 3
Figure 3
Funnel plot representing the absence of publication bias
See this image and copyright information in PMC

Comment in

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. WHO. Global Health Estimates 2016: deaths by cause, age, sex, by Country and by Region, 2000–2016. Geneva: World Heal Organization; 2018.
    1. Eastridge BJ, Holcomb JB, Shackelford S. Outcomes of traumatic hemorrhagic shock and the epidemiology of preventable death from injury. Transfusion. 2019;59:1423–8. - PubMed
    1. Gruen RL, Brohi K, Schreiber M, et al. Haemorrhage control in severely injured patients. Lancet. 2012;380:1099–108. - PubMed
    1. McDaniel LM, Etchill EW, Raval JS, Neal MD. State of the art: massive transfusion. Transfus Med. 2014;24:138–44. - PubMed
    1. Treml AB, Gorlin JB, Dutton RP, Scavone BM. Massive transfusion protocols: a survey of Academic Medical Centers in the United States. Anesth Analg. 2017;124:277–81. - PubMed