Standardized Calcium Replacement in Massive Transfusion: A Quality Improvement Project.

Area of Science:

• Trauma Care
• Critical Care Medicine
• Biochemistry

Background:

• Hypocalcemia is a frequent complication in trauma patients undergoing massive transfusion.
• It exacerbates coagulopathies, increasing morbidity and mortality.
• Standardized calcium replacement protocols are underutilized despite recommendations.

Purpose of the Study:

• To evaluate the impact of a revised massive transfusion protocol on calcium administration rates.
• To assess the effectiveness of standardized calcium replacement in trauma patients receiving massive transfusions.

Main Methods:

• Retrospective pre-/post-intervention quality improvement study.
• Analysis of data from an urban Level I academic trauma center (January-October 2022).
• Compared calcium administration and ionized calcium monitoring rates before and after protocol revision.

Main Results:

• Calcium administration increased from 78% to 98% post-intervention.
• Massive transfusion protocol activations were predominantly in the trauma bay (79%).
• Ionized calcium monitoring decreased by 14% post-intervention.

Conclusions:

• Standardized calcium replacement protocols effectively improve calcium administration in massive transfusion patients.
• Further research is needed to optimize dosing and ensure adequate ionized calcium levels.
• Protocol revisions can enhance patient care in critical trauma scenarios.