Adherence to low volume massive hemorrhage protocol: Experience from an urban level 1 trauma center

Adherence to the massive hemorrhage protocol (MHP) is essential for its successful implementation. An indigenous low-volume MHP was designed in accordance with the institutional needs. Adherence to various components of the designed MHP components was assessed.

Retrospective analysis of all MHP activations for 1-year duration was performed. Patient demographics, injury details, and baseline vitals were collected along with details of transfusion. Adherence to critical steps such as activation criteria, timing of delivery of the blood components, pack size and ratios of blood components, and endpoints were assessed, followed by calculation of adherence scores.

MHP was activated in 1.1% of patients presenting to the emergency. Massive transfusions were required for 76%. Adherence scores of ≥50% were achieved in 77% of MHP activations. Timely issue of the first transfusion pack was achieved in all cases, whereas the demand for the red blood cell (RBC) components exceeded the predefined number of units, thus affecting the desired ratio of blood components. Hemorrhagic deaths within 24 h were observed in 13 patients and were not affected by the overall adherence scores.

Adherence to prepared MHP was moderate for most patients. Adherence can be improved significantly by increasing the number of compatible blood components after the first transfusion pack in case of limited inventory. In addition, reducing the delivery time for the subsequent transfusion packs, incorporation of hemostatic adjuncts, and point-of-care tests in the MHP should be considered on a priority basis.