E. M. Campion1, L. Z. Kornblith1, E. W. Fiebig2, B. J. Redick1, R. A. Callcut1, M. J. Cohen1 2University Of California – San Francisco,Laboratory Medicine,San Francisco, CA, USA 1University Of California – San Francisco,Surgery,San Francisco, CA, USA
Introduction:
Blood product resuscitation has undergone a recent evolution driven by the concept of damage control hemostasis. This approach encourages a balanced ratio of packed red blood cells to fresh frozen plasma approaching 1:1. While the mortality benefits have been elucidated, this strategy raised concerns about overuse of blood products and the potential for straining blood bank resources. We hypothesized that adoption of damage control hemostasis would decrease overall hospital blood product usage and wastage.
Methods:
Blood use records from a major Level I Trauma Center were queried for all units of packed red blood cells(pRBCs), fresh frozen plasma(FFP), and platelets (PLT) transfused to the inpatient (medical and surgical) population from 2003-2011. Diagnosis, injury severity, demographics and hospital case mix data were analyzed. Linear regression was performed to determine if a trend in blood product usage existed.
Results:
The study period(2003-2011) encompassed 132,443 patient discharges and 27,498 trauma activations. 124,093 blood units were transfused during this time. The patient population was consistent by diagnosis, ISS and demographics(p=NS). However, pRBC use had a significant decrease of 405.4 units per year (p<0.001). FFP had a non-significant increase of 6.48 units per year (p=0.845) and PLT had a non-significant decrease of 2.13 units per year (p=0.868). Over the study period, the hospital wide ratio of pRBC to FFP decreased from 2.9 to 2.0 (p=0.001) and the total hospital blood use decreased by 401.0 units per year (p=0.002).
Conclusion:
During the period of transition to hemostatic resuscitation, the total hospital blood use and PRBC use decreased significantly amongst medical and surgical patients. Despite worry to the contrary, adoption of hemostatic resuscitation is likely associated with decreased total hospital blood product usage.
