Improvement of Treatment Outcomes after Implementation of a Massive Transfusion Protocol: A Level I Trauma Center Experience
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)...
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Published in | The American surgeon Vol. 83; no. 4; pp. 394 - 398 |
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Main Authors | , , , , , |
Format | Journal Article |
Language | English |
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SAGE Publications
01.04.2017
SAGE PUBLICATIONS, INC |
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Abstract | 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. |
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AbstractList | 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. 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. 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 ([Dagger]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 5 0.04) and intensive care unit length of stay from 31 to 26 days (P 5 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. |
Author | Templin, Megan Christmas, A. Britton Sing, Ronald Avery, Michael Nunn, Andrew Fischer, Peter |
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CitedBy_id | crossref_primary_10_1111_voxs_12428 crossref_primary_10_1111_acem_14580 crossref_primary_10_20408_jti_2020_022 crossref_primary_10_1016_j_amjsurg_2022_06_017 crossref_primary_10_1016_j_jss_2018_08_007 crossref_primary_10_1097_ACO_0000000000001346 crossref_primary_10_3238_arztebl_2019_0799 crossref_primary_10_1007_s00268_017_4441_5 crossref_primary_10_1097_JTN_0000000000000722 crossref_primary_10_1097_SLA_0000000000003313 crossref_primary_10_1111_trf_16410 crossref_primary_10_1097_SLA_0000000000003657 crossref_primary_10_3390_jcm10020362 crossref_primary_10_1007_s00068_021_01788_9 crossref_primary_10_1097_JTN_0000000000000350 |
Cites_doi | 10.1001/jama.2015.12 10.1097/01.ta.0000219013.64168.b2 10.1097/TA.0b013e3181d3cc25 10.1097/00005373-198910000-00020 10.1097/00005373-199502000-00006 10.1097/TA.0b013e3181a59ad5 10.1001/2013.jamasurg.387 10.1001/archsurg.143.7.686 10.1007/BF03018233 10.1111/tme.12125 10.1016/S0149-2918(98)80011-8 10.1097/TA.0b013e31816c5c80 10.1097/TA.0b013e3181271ba3 10.1097/CCM.0b013e31817da7dc 10.1093/bja/85.3.487 10.1097/00005373-199809000-00022 10.1016/S0168-8510(98)00044-X 10.1097/01.ta.0000199549.80731.e6 10.1097/TA.0b013e318227edbb |
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SubjectTerms | 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 |
Title | Improvement of Treatment Outcomes after Implementation of a Massive Transfusion Protocol: A Level I Trauma Center Experience |
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