I. A. Struve1, E. S. Salcedo1, C. S. Marshall1, J. M. Galante1 1University Of California – Davis,School Of Medicine,Sacramento, CA, USA
Introduction: The Massive Transfusion Protocol (MTP) facilitates rapid transfusion of blood components for patients in hemorrhagic shock. MTP implementation is highly resource intensive. Rapid deployment of all available transfusion service personnel is necessary to prepare and issue blood products promptly. This study explores factors contributing to appropriate blood product use with MTP activation in a Level 1 Trauma Center. We aim to establish a quality benchmark for the use of a limited resource.
Methods: Records of patients, for whom MTP was activated, from 3-month intervals over three consecutive years, were reviewed. Data collected includes: ordering specialty, patient location at the time of activation, and units transfused at 6 hours and at 24 hours. The primary outcome assessed was zero-use rates, which were compared by ordering specialty and patient location at the time of MTP activation. Zero-use was defined as zero PRBC units transfused at 24 hours following MTP activation. Secondary outcomes assessed were median PRBC units transfused and Crossed-To-Transfused (C:T) ratios, both compared by specialty and location. Categorical variables were compared with the chi-square test and continuous variables with confidence intervals using alpha=0.05.
Results: MTP was activated for 183 patients. The predominant specialties that activated MTP were emergency medicine (43%), surgery (24%), and anesthesia (22%), The predominant patient locations at the time of MTP activation were the ER (50%) and the OR (43%). Zero-use rates compared between predominant ordering specialties were not significant (p=0.75). Zero-use rates compared between the ER and the OR were significant (p=0.008) (Table 1). When MTP did not result in zero use, only activations made with the patient in the OR results in massive transfusion (MT) (6 units) (Table 1).
Conclusion: Patient location at the time of MTP activation is a significant predictor of appropriate MTP use. The OR is superior likely because the source and extent of hemorrhage is directly visualized. In the OR, zero-use rates are lowest and the median number of transfused units are 6 within 6 hours, an accepted definition of massive transfusion. Using the OR as a model for appropriate MTP activation, we propose a zero-use rate benchmark of 15%.
