Optimum Accuracy of Massive Transfusion Protocol Activation: The Clinician's View

Area of Science:

• Emergency Medicine
• Transfusion Medicine
• Health Services Research

Background:

• Massive transfusion protocols (MTP) are crucial for managing exsanguinating patients.
• Current MTP activation criteria lack optimal accuracy, leading to blood product wastage or under-activation.
• Refining MTP activation criteria is essential to balance efficiency, patient outcomes, and resource management.

Purpose of the Study:

• To survey Canadian clinicians regarding acceptable over- and under-activation rates for MTP.
• To identify potential differences in MTP activation criteria perception between trauma/acute care specialists and clinical/laboratory medicine specialists.
• To inform the development of improved MTP activation strategies.

Main Methods:

• A snowball survey technique was used to recruit Canadian content experts.
• Respondents were divided into two groups: Trauma and Acute Care Specialists (TACS) and Clinical and Laboratory Medicine Specialists (CLMS).
• Fisher's exact test and likelihood ratio were used to examine between-group differences (p < 0.05).

Main Results:

• Responses were received from 35 TACS and 10 CLMS.
• Acceptable MTP over-activation rates of 5%-10% were similar between TACS (45.7%) and CLMS (60%).
• Acceptable MTP under-activation rates <5% were considered by 34.2% of TACS vs. 60% of CLMS.
• TACS were more likely to accept >20 units of packed red blood cells in 24 hours as an MTP activation criterion.
• CLMS identified "poor communication" as a significant factor in blood wastage.

Conclusions:

• Acceptable MTP over- and under-activation rates show similarities across specialties.
• Effective MTP protocol development requires collaboration between TACS and CLMS.
• Improved MTP strategies can enhance patient outcomes and minimize blood product wastage.