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Massive Transfusion Protocol - A Survey of Academic Hospitals
Abstract Number: F-77
Abstract Type: Original Research
Massive Transfusion Protocol: A Survey of Academic Hospitals
Grant T, Banayan J, Treml A, Scavone B
Introduction: Massive transfusion is defined as transfusion of 10 or more units of red blood cells (RBCs) in 24 hours, replacement of 50% of blood volume in 3 hours, and life-threatening hemorrhage(1). Previous studies have suggested an improvement in morbidity and mortality when plasma (FFP) transfusions are initiated earlier and in a closer ratio to the number of RBCs transfused during massive transfusion(2,3). As a result, many hospitals have developed massive transfusion protocols (MTPs) to help improve efficiency of blood product delivery, decrease costs, and ensure proper ratios(4). Implementation of MTPs improves patient outcomes compared to physician-driven resuscitation(4). However, no guidelines exist regarding details of MTP and what RBC:FFP ratio should be used. The purpose of our study was to determine the proportion of academic hospitals across the US that employ a MTP and to learn the details of commonly-used MTPs.
Methods: In this IRB-exempt study we designed a web-based survey inquiring about MTP practices and sent it to each of the 107 US academic hospitals with anatomic and clinical pathology residency programs.
Results: Fifty-six of 108 programs responded (52% response rate): all had a MTP in place, despite varying numbers of inpatient beds and trauma level statuses. The majority (n=48, 86%) of respondents had fixed ratio MTPs and 41 (73%) had goal RBC:FFP ratios of 1:1. Seven (13%) had a combination fixed ratio and lab-driven MTP and 1 (2%) was solely lab-driven. Most hospitals provided 6 units RBCs and 6 units FFP in the first MTP pack. Only 5 (9%) did not include any plasma in the first pack. Platelets were included in the first pack in 36 (64%) of protocols and cryoprecipitate was routinely included by only 1 (2%) institution. Thirteen of 51 hospitals with an obstetric service (25%) provide a separate protocol for labor and delivery, which often included more cryoprecipitate. Eighty-two percent of respondents felt their MTP was extremely or mostly effective.
Conclusion: MTPs are widespread in US academic hospitals across hospital size and trauma levels. Little variation in MTPs exists despite a lack of formal guidelines regarding recommended RBC:FFP ratios. The majority of the protocols have a goal RBC:FFP ratio of 1:1. MTPs are felt to be highly effective.
1. Erber: Transfusion and Apheresis Science 2002; 27:83-92
2. Borgman: J Trauma 2007; 101:44-54
3. Holcomb: Hematology Am Soc Hematol Educ Program 2010; 2010:465-469
4. Malone: J Trauma 2006; 60:S91-6