Acute and uncontrolled blood loss is a leading cause of early mortality and management of patients that require massive transfusion (MT) continues to represent a significant challenge. The development of MT protocols have dramatically improved patient outcomes due to the rapid restoration of haemostasis, but are hindered by reports of infection and organ failure.
Transfusion of more than six units of red blood cells within the first 12 hrs after injury has previously been reported to be the strongest independent predictor of multiple organ failure. Thus despite the potentially life-saving effects of MTs, the associated risks are still of real concern. Moreover the most appropriate ratio of blood components is still hotly debated and no clear answer exists in the literature.
Ideally many of these questions should be addressed through clinical trials. Conduct of clinical trials in these patients is difficult due to the heterogeneity of the patients, protocol compliance in the frantic setting of acute haemorrhage, and ethical issues. Establishment of the Massive Transfusion Registry will not provide data as convincing as that of a clinical trial. However it will provide valuable observational data regarding the safety, ratio of blood components transfused and adverse events. In addition, it will provide valuable baseline data that will in time enable development of carefully focused and well planned randomised controlled trials.
Currently, no registry exists to monitor massively transfused patients in the acute setting either to understand current practice, or to track the occurrence of adverse events. An additional focus of the MT Registry will be to gain information on safety, efficacy, appropriateness of use and dosages of adjunctive agents used in the treatment of critically bleeding patients.
The Massive Transfusion Registry is supported by Monash University, the Australian Red Cross Blood Service, CSL Behring, the New Zealand Blood Service, Victorian Department of Health and Human Services, St John of God Pathology, the National Blood Authority and the Centre of Research Excellence for Patient Blood Management in Critical Illness and Trauma.
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