Use of a massive transfusion protocol in nontrauma patients: activate away

Lauren M McDaniel, Matthew D Neal, Jason L Sperry, Louis H Alarcon, Raquel M Forsythe, Darrell Triulzi, Andrew B Peitzman, Jay S Raval
Journal of the American College of Surgeons 2013, 216 (6): 1103-9

BACKGROUND: Recently, concern has been raised that the use of massive transfusion protocols (MTPs) in nontrauma (ie, general medical/surgical [GMS]) patients might be inefficient due to protocol overactivation (activation in patients who do not ultimately receive massive transfusion). The current study was designed to investigate whether an MTP could be used effectively in GMS patients without detrimentally impacting resource allocation.

STUDY DESIGN: A retrospective analysis was performed using institutional blood bank records from 2011. Trauma and GMS patients who had ≥10 U packed RBC issued to them in a single release were identified and categorized into MTP and no MTP (nMTP) cohorts.

RESULTS: The protocol was overactivated in 53.8% of GMS patients. Activation of the MTP accelerated the delivery of component products for all patients. In GMS MTP patients, fresh frozen plasma units were issued a median of 7 minutes earlier than in GMS nMTP patients (MTP: median 1.0 minute; interquartile range [IQR] 0.0 to 2.0 minutes vs nMTP: median 8.0 minutes; IQR 0.0 to 37.5 minutes; p = 0.009), and platelet units were issued 17 minutes earlier (MTP: median 7.0 minutes; IQR 0.0 to 15.0 minutes vs nMTP: median 24.0 minutes; IQR 9.0 to 96.0 minutes; p = 0.010). In GMS MTP patients, there was a statistically significant increase in the percentage of platelet units wasted (MTP 12.8% vs nMTP 8.1%; p = 0.046). This increase was also seen in trauma MTP patients (MTP 12.2% vs nMTP 4.0%; p < 0.001).

CONCLUSIONS: Despite finding that our MTP is overactivated in GMS patients, we could identify no unique disadvantages to its use with respect to resource allocation. In fact, a potential advantage to MTP activation exists, as products are issued more quickly with less variability. Our findings of increased platelet waste were not unique to GMS patients and should be used as a metric for quality improvement.

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