G. Moore1, Z. Aldaher1, B. Bays1, R. Medeiros1, E. Switzer1, A. Lee1, B. Adam1, E.S. Mabes1 1Medical College Of Georgia, Surgery, Augusta, GA, USA
Introduction:
Massive transfusion protocol (MTP) is implemented at large trauma centers to address life-threatening hemorrhage and coagulopathy. It is lifesaving in the unstable polytrauma patient yet a common challenge to reach the appropriate ratio of administration of blood products. MTP ratio non-compliance occurs from provider knowledge deficits, bias, and systemic/structural barriers. As a level one trauma center with ongoing performance improvement (PI) data, we performed a needs assessment for MTP education to facilitate development of an MTP multidisciplinary simulation curriculum.
Methods:
A systematic search including PubMed, NLM, Scopus, and ScienceDirect was performed on MTP training and deficiencies. Inclusion criteria was MTP training programs/gaps, MTP simulation education and intraoperative hemorrhage requiring MTP. Exclusion criteria was pediatric patients, obstetrical hemorrhage, projects performed outside of the US and prior to 2005. Ongoing PI data at our level one trauma center was reviewed pertaining to MTP activations with data gathered specifically identifying location of activations/transfusions and ratios of blood product transfusion.
Results:
Literature review identified eight studies and five met criteria. MTP simulation training improved providers’ knowledge and confidence to perform tasks within their defined role in the algorithm. While literature demonstrates educational sessions improve certain PI measures such as MTP ratio compliance, it does not impact early activation of MTP in the emergency department (ED). This identified the need for adjunctive procedural/skills training for MTP activations to improve compliance of all PI variables. Our institutional PI data demonstrated inconsistent compliance of MTPs transfused at 1:1 ratio throughout 2023 but did demonstrate improved 1:1 transfusion ratio when comparing the first 6 months of 2023 to the last 6 months (figure 1A). A significant variation was noted when comparing MTP transfusion ratio compliance in the ED with transfusion ratio when MTP was started in the ED and transitioned to the operating room (OR) or when initiated in OR alone (73% vs 50% vs 49% compliance, respectively) (figure 1B).
Conclusion:
Expeditious and appropriately administered MTPs can be life-saving in the unstable trauma patient. This needs assessment identified variability in MTP compliance within our institution detecting a significant decrease in compliance with transition from the ED to the OR. This data highlights the need for development of a multi-disciplinary, team-based simulation curriculum that will aim to improve institutional adherence of MTP throughout trauma resuscitations and to specifically target MTP compliance from ED to OR.