A. Hospital demographics 1. Contact details Name of the Hospital Last name of person in charge First name of person in charge City Country 2. Demographics # of inpatient beds # of operating rooms # of surgical procedures / year # of anaesthesiologists board certified # of anaesthesiologists in training 3. Specialities at the Hospital (tick all that apply) Orthopaedics Ear Nose Throat Dental Surgery Urology Thoracic Surgery Plastics/Cutaneous Gynaecology Cardiac surgery Visceral surgery Vascular Surgery Neurosurgery Ophthalmology Trauma Hepato biliary Surgery Other (please specify) B. Transfusion habits 1. At your hospital, how many of your patients (%) are preoperatively prepared... with oral iron? with i.v iron? with erythropoetin? 2. Is a transfusion and coagulation management protocol in use in your hospital? Page 1
If, your protocol is based on (tick all that apply): Packages Point Of Care (POC) testing FFP PRBC Ratio Experience Conventional laboratory tests If, when do you start your massive transfusion protocol? (tick the most appropriate) Start of transfusion of prbc Treshold of bloodloss Start of transfusion of FFP Other (please specify) 3. What kind of devices do you use to monitor perioperative haemostasis? (tick all that apply) Conventional laboratory tests Point Of Care (POC) testing No monitoring If 'Conventional laboratory tests', which devices do you use? (tick all that apply) PT/INR Fibrigen aptt Platelet count If 'Point Of Care (POC) testing', which devices do you use? (tick all that apply) ACT ROTEM PT/INR Platelet Mapping, Multiplate or Verify Now TEG 4. Who is responsible for perioperative transfusion and coagulation management in your hospital? (tick the most appropriate) Anaesthetist Haematologist Surgeon Transfusion medicine Intensivist Nobody Someone else (please specify) Page 2
5. Which coagulation factor concentrates are used in your hospital? (tick all that apply) Fibrigen concentrate Prothrombin complex concentrate (PCC) Factor XIII concentrate Recombinant activated factor VII (rfviia) Please specify the indication of each concentrate used 5 6. Who decides to use coagulation factor concentrates such as fibrigen concentrate, factor XIII concentrate, prothrombin complex concentrate (PCC), or recombinant activated factor VII (rfviia)? (tick the most appropriate) 6 Anaesthetist Haematologist Surgeon Transfusion medicine Intensivist Nobody Someone else (please specify) 7. Do you have an interdisciplinary task force for bleeding management at your hospital? 8. Do you use any scoring system to predict massive transfusion? If '', which scoring system do you use? ABC Score Vandromme Score McLaughlin Score TASH Score ETS Score RTS Score PWH Score ROTEM Score Any other score (please specify) 9. Do you use cryoprecipitates? Page 3
10. Are cryoprecipitates part of your massive transfusion packages? If, what is the indication to use cryoprecipitate in your hospital? 11. Do you use prethawed FFP in your hospital? 12. Do you use n leukocyte reduced prbc in your hospital? 13. Do you use ABO compatible but n identical PRBC in your hospital (e.g., 0 neg. if blood group is t yet kwn)? 14. Do you use ABO compatible but n identical platelet concentrates in your hospital? 15. Do you use ABO incompatible platelet concentrates in your hospital? 16. Do you use ABO compatible but n identical FFP in your hospital? Page 4
17. If FFPs are administered, what is the frequency distribution of FFP transfusion in your hospital? never rarely sometimes often 1 2 units 3 4 units 5 9 units 10 15 units > 15 units 18. Do you use any warming device to avoid or treat hypothermia? If, please specify 5 6 19. Is a treatment of metabolic acidosis triggered? If, please specify when 5 6 20. Do you use bicarbonate? 21. Do you use TRIS buffer? 22. Do you use antifibrilytics (e.g. tranexamic acid)? Page 5
If, under which conditions? (tick the most appropriate) On regular basis in some clinical settings Based on the clinical situation Based on Point Of Care (POC) testing results 23. Is a liberal or restrictive transfusion regime most commonly used in your hospital? liberal restrictive for prbc for FFPs for coagluation factors for platelets Page 6