S. Jammula1, C. Morrison1 1Penn Medicine Lancaster General Health,Trauma Services,Lancaster, PA, USA
Introduction: While massive transfusion protocols (MTPs) are effective means of expeditiously delivering blood products to patients with exsanguinating hemorrhage, activation often occurs in cases with small blood volume deficits, leading to blood product wastage and over-transfusion. We sought to determine whether the implementation of a rapid release of blood products protocol (RR), which utilizes less resources, would impact the manner in which MTPs were activated in our level II trauma center, and if decreases in blood product wastage would be observed. We hypothesized that RR would result in the reservation of MTPs for sicker patients and that blood product wastage would decrease.
Methods: All MTP activations one year pre (May 2015-2016) and post-RR (May 2016-2017) were analyzed. Compared to MTP (6 pack red blood cells [RBCs], 6 units fresh frozen plasma [FFP]), RR only releases 4 RBCs and 1 FFP per activation. MTP resource utilization and blood product wastage was compared pre to post RR in both trauma and non-trauma populations. p ≤ 0.05 was considered significant.
Results: A total of 61 MTPs were activated pre (n=24) to post (n=37) RR (Trauma: 36; non-Trauma: 25), with 34 RRs activated in the post-RR period. Compared to the pre-RR group, significantly higher transfusion rates for FFP (Pre: 4.46±7.91 units, Post: 9.20±10.5 units; p=0.050) and platelets (Pre: 0.79±1.35 units, Post: 1.68±1.86 units; p=0.036) were found. Higher, albeit non-significant, transfusion rates were also observed for RBCs and cryoprecipitate pre to post for the total population. No difference in wasted blood products was found pre to post RR within the trauma population, however significant increased waste of FFP was observed post-RR in the non-trauma cohort.
Conclusion: Institution of the RR protocol results in more appropriate activation of MTPs, but does not decrease waste within a mature trauma center.