Toward Standardized Massive Transfusion Protocols: A Multicenter Evaluation of Practice Variability Within a National...

Area of Science:

• Trauma Surgery
• Emergency Medicine
• Critical Care Medicine

Background:

• Hemorrhage is a primary cause of early mortality in trauma patients.
• Effective management relies on timely transfusion via a massive transfusion protocol (MTP).
• Standardized MTPs are underdeveloped in many regional trauma systems.

Purpose of the Study:

• To evaluate current MTP practices in five major trauma centers.
• To identify variations and gaps in MTP implementation.
• To compare practices against international recommendations.

Main Methods:

• Institutions submitted written protocols and completed surveys.
• Key domains assessed: activation, transfusion, monitoring, adjuncts, termination, and improvement.
• Data analyzed and benchmarked against international standards.

Main Results:

• All centers had MTPs and could provide initial blood products within 15 minutes.
• Significant variation existed in activation criteria, transfusion ratios, and lab monitoring.
• No centers kept thawed plasma or whole blood readily available; only one had formal performance monitoring.
• Tranexamic acid was universally included.

Conclusions:

• Substantial variability and critical gaps in MTP implementation were identified.
• Inconsistent criteria, missing components, and poor monitoring may hinder efficacy.
• A standardized, evidence-based MTP framework is needed nationwide to enhance patient outcomes.