Quality management of a massive transfusion protocol.

Area of Science:

• Emergency Medicine
• Trauma Surgery
• Critical Care

Background:

• Massive transfusion is a critical response to severe hemorrhage, requiring timely blood volume, oxygen transport, and hemostasis.
• Effective massive transfusion protocols (MTPs) are essential in managing uncontrolled bleeding.

Purpose of the Study:

• To review all massive transfusion protocol (MTP) activations in a major hospital.
• To determine the appropriateness of MTP use by analyzing indications, transfused amounts, and outcomes.
• To assess the impact of MTP activation on patient outcomes, particularly in trauma cases.

Main Methods:

• A retrospective review of all MTP activations was conducted.
• Data collected included indications for activation, blood product volumes transfused, and patient outcomes.
• Descriptive statistics, categorical associations, and trend analyses were used to evaluate MTP use.

Main Results:

• The MTP was activated 309 times in 2016, primarily for trauma (237), gastrointestinal bleeding (29), and ruptured abdominal aortic aneurysms (16).
• Trauma activations averaged 6.6 units of RBCs, 6.5 units of plasma, and 1.2 units of platelets, with a 15% mortality rate.
• Only 19% of activations met the traditional definition of massive transfusion (≥10 RBC units), and 14% did not meet a critical administration threshold of three components.

Conclusions:

• Massive transfusion protocol activations were frequent and adhered to a 1:1:1 component ratio.
• Prompt availability of blood components correlated with reduced overall component usage and lower mortality in trauma patients.
• The study suggests MTPs can be implemented effectively without leading to overuse of blood products.