Improvements in National Code Red transfusion practice in Scotland after adoption of recommendations from the Scottish National Code Red 2015 review

, Matthew J. Reed (Lead / Corresponding author), Claire Cooke, Niall McMahon, Katherine Hands, Susan Henderson, Eleanor Knight, Nicola Littlewood, Munsoor Latif, Naomi Tod, Margaret McGarvey, Neil Hughes, Michael Donald, Megan Rowley, Catherine Innes, Symon Lockhart

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    Abstract

    Aims: The Scottish Transfusion and Laboratory Support in Trauma Group (TLSTG) previously reviewed all National Code Red activations between June 1st 2013 and October 31st 2015, generating a number of recommendations to be adopted to optimise the transfusion support given to patients following major trauma in Scotland. A repeat National survey was undertaken for all patients for whom Code Red was activated between 1st November 2015 and 31st December 2017. Methods: A clinical and transfusion lead for each centre entered anonymised data onto a secure electronic database (REDCap). Results: During the study period there were 66 activations (24 South-East of Scotland, 32 West, 10 East). Mean age was 45 years and 88% were male. Mean Injury Severity Score (ISS) was 28 with 75% blunt trauma. 93% (62/66) of Code Red patients received blood components with a 300% increase in pre-hospital transfusion (48 vs 16 patients; p<0.001). Median time from 999 call to Code Red activation reduced significantly to 37 min from 70 min (p = 0.01) giving the hospital more time to prepare transfusion components. 78% patients received pre-hospital tranexamic acid (TXA; improved from 70%, p = 0.67, ns). Concentrated Red Cell (CRC): Fresh Frozen Plasma (FFP) ratio was always less than 2:1 and below 1.4:1 at 90 min, compared to 2013–15 when CRC: FFP ratios did not drop to below 2:1 until 150 min after arrival in the ED. Mean time for Full Blood Count (FBC; 46 mins versus 81; p = 0.004) and clotting (53 mins versus 119; p<0.001) result was reduced. Survival to hospital discharge was unchanged (66% versus 63%; p = 1.00 ns). Conclusions: Code Red practice has improved in several ways since our last survey with earlier Code Red activation, more patients receiving pre-hospital transfusion and improved CRC:FFP ratios. Interventions such as earlier on scene Code Red activation, provision of pre-hospital TXA, Emergency Department (ED) resuscitation room pre-thawed FFP and point-of-care viscoelastic coagulation testing have all contributed to these improvements in transfusion practice in Scotland.

    Original languageEnglish
    Pages (from-to)913-918
    Number of pages6
    JournalInjury
    Volume51
    Issue number4
    Early online date18 Feb 2020
    DOIs
    Publication statusPublished - Apr 2020

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    Keywords

    • Massive transfusion
    • Critical care
    • Trauma

    Cite this

    , Reed, M. J., Cooke, C., McMahon, N., Hands, K., Henderson, S., Knight, E., Littlewood, N., Latif, M., Tod, N., McGarvey, M., Hughes, N., Donald, M., Rowley, M., & Innes, C., & Lockhart, S. (2020). Improvements in National Code Red transfusion practice in Scotland after adoption of recommendations from the Scottish National Code Red 2015 review. Injury, 51(4), 913-918. https://doi.org/10.1016/j.injury.2020.02.079