RT Journal Article
SR Electronic
T1 Development of a national out-of-hospital transfusion protocol: a modified RAND Delphi study
JF CMAJ Open
JO CMAJ
FD Canadian Medical Association
SP E546
OP E559
DO 10.9778/cmajo.20220151
VO 11
IS 3
A1 von Vopelius-Feldt, Johannes
A1 Lockwood, Joel
A1 Mal, Sameer
A1 Beckett, Andrew
A1 Callum, Jeannie
A1 Greene, Adam
A1 Grushka, Jeremy
A1 Khandelwal, Aditi
A1 Lin, Yulia
A1 Nahirniak, Susan
A1 Pavenski, Katerina
A1 Peddle, Michael
A1 Prokopchuk-Gauk, Oksana
A1 Regehr, Julian
A1 Schmid, Jo
A1 Shih, Andrew W.
A1 Smith, Justin A.
A1 Trojanowski, Jan
A1 Vu, Erik
A1 Ziesmann, Markus
A1 Nolan, Brodie
YR 2023
UL http://www.cmajopen.ca/content/11/3/E546.abstract
AB Background: Early resuscitation with blood components or products is emerging as best practice in selected patients with trauma and medical patients; as a result, out-of-hospital transfusion (OHT) programs are being developed based on limited and often conflicting evidence. This study aimed to provide guidance to Canadian critical care transport organizations on the development of OHT protocols.Methods: The study period was July 2021 to June 2022. We used a modified RAND Delphi process to achieve consensus on statements created by the study team guiding various aspects of OHT in the context of critical care transport. Purposive sampling ensured representative distribution of participants in regard to geography and relevant clinical specialties. We conducted 2 written survey Delphi rounds, followed by a virtual panel discussion (round 3). Consensus was defined as a median score of at least 6 on a Likert scale ranging from 1 (“Definitely should not include”) to 7 (“Definitely should include”). Statements that did not achieve consensus in the first 2 rounds were discussed and voted on during the panel discussion.Results: Seventeen subject experts participated in the study, all of whom completed the 3 Delphi rounds. After the study process was completed, a total of 39 statements were agreed on, covering the following domains: general oversight and clinical governance, storage and transport of blood components and products, initiation of OHT, types of blood components and products, delivery and monitoring of OHT, indications for and use of hemostatic adjuncts, and resuscitation targets of OHT.Interpretation: This expert consensus document provides guidance on OHT best practices. The consensus statements should support efficient and safe OHT in national and international critical care transport programs.