Improvement of Treatment Outcomes after Implementation of a Massive Transfusion Protocol: A Level I Trauma Center Experience

• Published in: The American surgeon Vol. 83; no. 4; pp. 394 - 398
• Main Authors: Nunn, Andrew, Fischer, Peter, Sing, Ronald, Templin, Megan, Avery, Michael, Christmas, A. Britton
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01.04.2017; SAGE PUBLICATIONS, INC
• Subjects: Abbreviated Injury Scale; Adult; Automation; Blood banks; Blood cells; Blood Component Transfusion - standards; Blood platelets; Blood products; Clinical outcomes; Clinical Protocols; Coma; Demographics; Erythrocytes; Evidence-based medicine; Female; Generalized linear models; Glasgow Coma Scale; Hospital Mortality; Humans; Intensive care; Length of Stay - statistics & numerical data; Male; Mortality; Outcome and Process Assessment (Health Care); Patients; Plasma; Quality Improvement; Ratios; Resuscitation; Resuscitation - standards; Retrospective Studies; Surgeons; Surgery; Transfusion; Trauma; Trauma Centers; Ventilators; Wounds and Injuries - mortality; Wounds and Injuries - therapy
• ISSN: 0003-1348; 1555-9823
• DOI: 10.1177/000313481708300429

We assessed the effectiveness of the implementation of an institutional massive transfusion protocol (MTP) for resuscitation with a 1:1:1 transfusion ratio of packed red blood cell (PRBC), fresh frozen plasma, and platelet units. In a Level I trauma center database, all trauma admissions (2004–2012) that received massive transfusions (≥10 units PRBCs in the first 24 hours) were reviewed retrospectively. Demographic data, transfusion ratios, and outcomes were compared before (PRE) and after (POST) MTP implementation in May 2008. Age, sex, and mechanism of injury were similar between 239 PRE and 208 POST trauma patients requiring massive transfusion. Transfusion ratios of fresh frozen plasma:PRBC and platelet:PRBC increased after MTP implementation. Among survivors, MTP implementation shortened hospital length of stay from 31 to 26 days (P = 0.04) and intensive care unit length of stay from 31 to 26 days (P = 0.02). Linear regression identified treatment after (versus before) implementation of MTP as an independent predictor of decreased ventilator days after adjusting for age, Glasgow Coma Scale, and chest Abbreviated Injury Score (P < 0.0001). Modest improvement in ratios likely does not account for all significant improvements in outcomes. Implementing a standardized protocol likely impacts automation, efficiency, and/or timeliness of product delivery.