Citation

Cotton BA. Trauma Surg. Acute Care Open 2024; 9(Suppl 2): e001448.

Copyright

(Copyright © 2024, The author(s) and the American Association for the Surgery of Trauma, Publisher BMJ Publishing Group)

DOI

10.1136/tsaco-2024-001448

PMID

38646027

PMCID

PMC11029276

Abstract

The last two decades have seen increased efforts at early identification of those likely to require life-saving interventions such as rapid response teams, massive transfusion delivery, extracorporeal membrane oxygenation, and emergent surgical procedures.1-3 However, it was not until recently that this same level of interest was directed at limiting early interventions in severely injured patients where such efforts might be futile. Not surprisingly, it was the COVID-19 pandemic and its disruption of vital supply chains that brought this to the forefront. During the early months of the COVID-19 pandemic, a 50% reduction in blood donations was offset by a significant drop in demand for products due to restrictions on elective surgery.4 However, as society and its institutions began reopening, with surgical schedules returning to 'normal' and trauma volumes rebounding, the supply of blood required was unable to keep up. Adding to this was an increase in trauma, particularly penetrating trauma, resulting in an estimated 12% surplus usage, combined with a loss of plasma products to convalescent programs.5 Finally, with increased attention to mass shootings and hospital disaster preparedness, surgeons and physicians have found the need to urgently address unforeseen critical shortages and vulnerability in the delivery of care.6

Although it took the extremes of the COVID-19 pandemic to expose the fragility of the healthcare system, the state of the industry had been problematic for decades, with many providers in the USA practicing for years with little regard for resource utilization. Although blood is but one of many precious resources we have shown disregard for, it is one in particular for which there is often no adequate substitute. Doughty et al responded by evaluating a triage tool for rationing of blood in massively bleeding patient in anticipation of the COVID-19 shortage.7 This tool and its processes were aimed at providing a transparent, 'fair' distribution of available blood resources. Their guideline would be triggered when a less than 2-day national supply was noted, with each hospital triaging bleeding patients to transfusion or assess for futility at predefined increments. The predominate factors guiding these triage lists were Sequential Organ Failure Assessment scores, need for ongoing transfusions, and likelihood of arrest from hemorrhage

Language: en

Keywords

adults; hemorrhage; wounds and injuries; young adult