5a83c2fdc67dd991cceb99ed60dda7d4 325966.pdf 1f55a22430f5c042110d8deecaae1ab2881a57c0 325966.pdf e1e1aff23e89364fce7bfaf8be5af4ed36338dcae700575ca99b5f26dc8534f5 325966.pdf Title: Improving the Compliance of Massive Hemorrhage Protocols Through Education Is Associated with Patient Survival Subject: Background: In 2015, Spanish scientific societies published a consensus document on managing massive hemorrhage (MH). This study aimed to evaluate the knowledge and application of the Massive Hemorrhage Protocol (MHP) among healthcare professionals and to assess whether an educational intervention could improve compliance and patient outcomes. Methods: A two-phase observational study was conducted in four Spanish university hospitals. In phase one, compliance with MHP recommendations was surveyed. Based on the findings, educational sessions were implemented, focusing on the least known or followed recommendations. Compliance was then reassessed. Primary outcome was adherence to MHP; secondary outcomes included morbidity and 24 h and in-hospital mortality. Results: The MHP was activated in 303 MH episodes, mostly of surgical (42.6%) or traumatic (25%) origin. The most followed recommendation before the intervention was protocol activation (94%), which improved to 98.3% post-intervention (p = 0.049). Lesser-followed recommendations such as requesting a hemorrhage lab panel and correcting hypothermia improved after intervention from 39% to 50.4% (p = 0.05) and 31.3% to 43.8% (p = 0.027), respectively. Overall compliance increased from 68% to 73% (p = 0.05). Mortality remained high in both phases, 24 h (25.4%) and in-hospital (42.2%). Patients who required massive transfusion had higher mortality (53.6%) than those who did not (35.9%, p = 0.03). Survivors had higher protocol compliance (p = 0.003 at 24 h; p = 0.049 in-hospital). Conclusions: Educational intervention modestly improved adherence to MHP recommendations. Higher compliance was associated with better survival outcomes, supporting the need for targeted educational strategies to enhance protocol implementation and improve care in MH cases. Keywords: massive hemorrhage; protocol compliance; education; mortality Author: Pilar Paniagua-Iglesias, Maria Dolores Rincón-Ferrari, Angel Candela-Toha, Maria Marcos-Jubilar, Marta Barquero-Lopez, Ignasi Gich-Saladich, Laura Medina-Marrero, Alba Bosch-Llobet, Daniela Garrido-Fleischmann, Jordi Ordoñez-Llanos and Gerard Urrutia-Cuchí Creator: LaTeX with hyperref Producer: pdfTeX-1.40.25 CreationDate: Tue Jul 1 08:39:34 2025 CEST ModDate: Tue Jul 1 08:42:56 2025 CEST Custom Metadata: no Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 16 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 616846 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- PLOLAK+VnURWPalladioL Type 1 Custom yes yes yes 10 0 WNAACY+URWPalladioL-Roma Type 1 Custom yes yes yes 16 0 VASGJU+URWPalladioL-Bold Type 1 Custom yes yes yes 22 0 PKQEJS+URWPalladioL-Ital Type 1 Custom yes yes yes 27 0 NWYVYM+CMSY10 Type 1 Builtin yes yes yes 56 0 NOAAHI+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 74 0 NOAAHK+PalatinoLinotype TrueType WinAnsi yes yes no 77 0 QLBIEB+URWPalladioL-BoldItal Type 1 Custom yes yes yes 88 0 NOAFCE+SegoeUIHistoric TrueType WinAnsi yes yes no 112 0 NOAFDG+Arial,Bold TrueType WinAnsi yes yes no 115 0 NOAAHI+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 118 0 NOAAHK+PalatinoLinotype TrueType WinAnsi yes yes no 121 0 NOAAHM+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 124 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2026-03-07 04:42:04 CET RepresentationInformation: 325966.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2026-03-06 10:48:41 CET Size: 616846 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 296 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: section.1 Item: Title: Materials and Methods Destination: section.2 Children: Item: Title: Study Design Destination: subsection.2.1 Item: Title: Preintervention Destination: subsection.2.2 Item: Title: Educational Intervention Destination: subsection.2.3 Item: Title: Postintervention Destination: subsection.2.4 Item: Title: Data Acquisition Destination: subsection.2.5 Item: Title: Study Endpoints Destination: subsection.2.6 Item: Title: Ethics Destination: subsection.2.7 Item: Title: Statistical Analysis Destination: subsection.2.8 Item: Title: Results Destination: section.3 Children: Item: Title: Clinical and Transfusion Data Destination: subsection.3.1 Item: Title: MHP Compliance and Outcomes Destination: subsection.3.2 Item: Title: Outcomes and Mortality Destination: subsection.3.3 Item: Title: Massive Transfusion Destination: subsection.3.4 Item: Title: Discussion Destination: section.4 Item: Title: Conclusions Destination: section.5 Item: Title: Patients Destination: section.6 Item: Title: References Destination: appendix.A. Info: Title: Improving the Compliance of Massive Hemorrhage Protocols Through Education Is Associated with Patient Survival Author: Pilar Paniagua-Iglesias, Maria Dolores Rincón-Ferrari, Angel Candela-Toha, Maria Marcos-Jubilar, Marta Barquero-Lopez, Ignasi Gich-Saladich, Laura Medina-Marrero, Alba Bosch-Llobet, Daniela Garrido-Fleischmann, Jordi Ordoñez-Llanos and Gerard Urrutia-Cuchí Subject: Background: In 2015, Spanish scientific societies published a consensus document on managing massive hemorrhage (MH). This study aimed to evaluate the knowledge and application of the Massive Hemorrhage Protocol (MHP) among healthcare professionals and to assess whether an educational intervention could improve compliance and patient outcomes. Methods: A two-phase observational study was conducted in four Spanish university hospitals. In phase one, compliance with MHP recommendations was surveyed. Based on the findings, educational sessions were implemented, focusing on the least known or followed recommendations. Compliance was then reassessed. Primary outcome was adherence to MHP; secondary outcomes included morbidity and 24 h and in-hospital mortality. Results: The MHP was activated in 303 MH episodes, mostly of surgical (42.6%) or traumatic (25%) origin. The most followed recommendation before the intervention was protocol activation (94%), which improved to 98.3% post-intervention (p = 0.049). Lesser-followed recommendations such as requesting a hemorrhage lab panel and correcting hypothermia improved after intervention from 39% to 50.4% (p = 0.05) and 31.3% to 43.8% (p = 0.027), respectively. Overall compliance increased from 68% to 73% (p = 0.05). Mortality remained high in both phases, 24 h (25.4%) and in-hospital (42.2%). Patients who required massive transfusion had higher mortality (53.6%) than those who did not (35.9%, p = 0.03). Survivors had higher protocol compliance (p = 0.003 at 24 h; p = 0.049 in-hospital). Conclusions: Educational intervention modestly improved adherence to MHP recommendations. Higher compliance was associated with better survival outcomes, supporting the need for targeted educational strategies to enhance protocol implementation and improve care in MH cases. 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