The status of massive transfusion protocols in United States trauma centers: massive transfusion or massive confusion?

Abstract

Background: Massive transfusion protocol (MTP) utilization and makeup is unknown.

Study design and methods: A Web-based survey was sent to members of the Eastern Association for the Surgery of Trauma and published in the American Association for the Surgery of Trauma newsletter. Comparisons were made with chi-square and logistic regression.

Results: A total of 186 surgeons and 59 center directors responded. To avoid bias, directors' responses are reported. Sixty percent annually admit more than 1500 patients. Sixty-seven percent had in-house attending coverage and 85% had a MTP. Presence of a MTP was not predicted by institution size, level, residency status, or admissions. Sixty-five percent of MTPs had been in place less than 5 years with 18% less than 1 year. Designs varied: 23% had one batch of components, 25% had two or three, 41% had more than three, and 11% did not use batches. Only 62% of first batches contained fresh-frozen plasma (FFP). In the second batch 98% had FFP. All third boxes had FFP. A ratio of FFP : red blood cells (RBCs) of less than 1 in the first batch predicted a ratio less than 1 in the second batch (p = 0.013). Twenty-seven percent had blood stored in the emergency department and 14% in the operating room. Twenty-four percent of MTPs autoactivate and 80% are trauma surgeon activated, 66% by the anesthesia staff, 32% by other surgeons, and 17% by the blood bank. Trauma surgeons activate the MTP most.

Conclusion: Most centers have a MTP. Protocols are variable and new, and half have a 1:1 FFP : RBC ratio. Protocols with fewer initial units of FFP compared to RBCs maintain this.