J. Williams1, C. E. Wade1, B. A. Cotton1 1McGovern Medical School at UTHealth,Acute Care Surgery,Houston, TEXAS, USA
Introduction: Recent guidelines from the American College of Surgeons Trauma Quality Improvement Program (TQIP) and the Eastern Association for the Surgery of Trauma (EAST) have made several recommendations for optimal resuscitation and transfusion of the bleeding patient. These guidelines were developed to improve outcomes in this patient population through a reduction in variation in massive transfusion protocols (MTP) at different institutions, including the recommendation of transfusion of products in ratio approximating 1:1:1 (plasma:platelets:red blood cells). However, there is little data showing how well these guidelines have been implemented. Moreover, given the concern for supporting care durig mass casualty events, there is no data evaluating the depth of product availability at these centers. The purpose of this study was to evaluate existing MTPs and on-hand blood products at academic level-1 trauma centers (TC) throughout the US and describe current and existing pratices.
Methods: Trauma directors at the 25 busiest US level-1 TCs were asked to complete an anonymous survey regarding their MTPs and a cross-sectional survey of on-hand blood products. Continuous data are presented as medians with the 25th and 75th percentile interquartile range (IQR). Categorical data are reported as proportions.
Results: Responses were obtained from 17 TCs, with all centers having an MTP in place. The median number of trauma admissions for calendar year 2016 for responding TCs was 2838 (IQR 1813-4888), with a median number of 54 MTP patients (IQR 38-107). 76% of responding TCs report using a 1:1 ratio of plasma:red blood cells for trauma resuscitation. 82% of responding TCs are using platelets either in their first or subsequent MTP coolers, with 58% of TCs reporting platelet use in their first MTP cooler. The most commonly reported transfusion ratio of platelets:plasma:RBCs was 1:1:1, with 35% of TCs using this ratio in their first MTP cooler, and 47% for subsequent MTP coolers. Additionally, 89% of TCs report using viscoelastic testing to guide resuscitation efforts. TABLE depicts median on-hand blood products across the 17 centers.
Conclusion: This study provides a snapshot of current MTP practices throughout the US at busy level-1 trauma centers. Although all surveyed programs have a MTP in place, variation exists in the ratio of blood products used despite clear recommendations from recent guidelines. Additionally, there is great variation in the quantity of blood products at TCs, especially with regards to platelets. Further action analysis is needed to understand how differences in MTPs affect patient outcomes.
