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. 2022 Feb;62(2):324-335.
doi: 10.1111/trf.16789. Epub 2021 Dec 31.

Transfusion practice in the bleeding critically ill: An international online survey-The TRACE-2 survey

Sanne de Bruin  1   2 , Dorus Eggermont  1 , Robin van Bruggen  2 , Dirk de Korte  2   3 , Thomas W L Scheeren  4 , Jan Bakker  5   6   7 , Alexander P J Vlaar  1 ; Cardiovascular Dynamics Section and Transfusion Task Force of the ESICM
Collaborators, Affiliations

Transfusion practice in the bleeding critically ill: An international online survey-The TRACE-2 survey

Sanne de Bruin et al. Transfusion. 2022 Feb.

Abstract

Background: Transfusion is very common in the intensive care unit (ICU), but practice is highly variable, as has recently been shown in non-bleeding critically ill patients practices survey. Bleeding patients in ICU require different blood products across a range of specific patient categories. We hypothesize that a large variety in transfusion practice exists in bleeding patients.

Study design and methods: An international online survey was performed among physicians working in the ICU. Transfusion practice in massively and non-massively bleeding patients was examined, including transfusion ratios, thresholds, and the presence of transfusion guidelines.

Results: Six hundred eleven respondents filled in the survey of which 401 could be analyzed, representing 64 countries. Among the respondents, 52% had a massive transfusion protocol (MTP) available at their ICU. In massively bleeding patients, 46% of the respondents used fixed transfusion component ratios. Of those who used fixed blood ratios, the 1:1:1 ratio (red blood cell [RBC] concentrates: plasma: platelet concentrates) was most commonly used (33%). The presence of an MTP was associated with a more frequent use of fixed ratios (p < .001). For RBC transfusion in the general non-massively bleeding ICU population, a hemoglobin (Hb) threshold of 7.0[7.0-7.3] g/dl was reported. In the general ICU population, a platelet count threshold of 50[26-50] × 109 /L was applied.

Discussion: Half of the centers had no massive transfusion protocol available. Transfusion practice in massively bleeding critically ill patients is highly variable and driven by the presence of an MTP. In the general non-massively bleeding ICU population restrictive transfusion triggers were chosen.

Keywords: bleeding; coagulation; critically ill; massive; transfusion; transfusion anemia.

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Conflict of interest statement

The authors have disclosed no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Six hundred eleven respondents filled in the survey of which 401 were analyzed (Panel A), representing 64 countries (Panel B) [Color figure can be viewed at wileyonlinelibrary.com]
FIGURE 2
FIGURE 2
The use of tranexamic acid (TXA) in massively (Panel A) and non‐massively (Panel B) bleeding patients in the ICU [Color figure can be viewed at wileyonlinelibrary.com]
FIGURE 3
FIGURE 3
Respondents were asked to report for the general bleeding ICU population and several subpopulations their Hb threshold (Panel A), platelet count threshold (Panel B), and fibrin threshold (Panel C) for RBC transfusion, platelet transfusion, and fibrin administration, respectively. Subpopulations were compared with the general ICU population using the Dunn test with Bonferroni correction. Each boxplot represents the medians with first and third quartile. The upper and lower whiskers are estimates of the 10th and 90th percentile, respectively [Color figure can be viewed at wileyonlinelibrary.com]
See this image and copyright information in PMC

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