M.KANG1, W.W.LIM1, J.T.T.GOO1
Khoo Teck Puat Hospital1
Critical Haemorrhage to Operation Room Patient (CHOP) protocol is a second-tier trauma activation that identifies major trauma patients likely to have massive haemorrhage. It was initiated in March 2018 in KTPH and is the first of its kind in Singapore. CHOP protocol activation mobilizes trauma resources by automated activation of surgical, anaesthesia, and interventional radiology specialists; standby of operating theatre, ICU, and blood bank services; as well as protocolizes trauma resuscitation via early blood transfusion and tranexamic acid.
Retrospective analysis of cases from the National Trauma Registry was performed comparing cases from 2015-2017 (preCHOP group) and cases from 2018-2020 (CHOP group) meeting criteria for CHOP activation. Primary outcomes were patient mortality and time taken to intervention.
There were 51 patients in the CHOP group and 54 in the preCHOP group. The majority of patients suffered blunt trauma after road traffic accidents. The average ISS was 37 in the CHOP group and 41 in the preCHOP group. There was a statistically significant improvement in mortality from 35.2% to 15.7% in the CHOP group and time to intervention from 106 minutes to 80 minutes (p<0.05). There was increased utilization of E-blood transfusion and tranexamic acid usage with 100% compliance in the CHOP group.
Utilization of CHOP protocol enables the rapid identification of critically injured patients and is associated with a significant decrease in mortality rate and time to intervention and improved compliance to protocolized trauma interventions such as blood product and tranexamic acid use.