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Massive Transfusion Protocol at a Level I Trauma Center: A Quality Improvement Project
Timothy Emhoff, *Bruce Simon, *Nam Heui KIm, *Ulises Torres, *Heena Santry
UMass Medical Center, Worcester, MA
Objective: Massive transfusion protocols (MTP) with a goal of infusing FFP:PRBC in a 1:1 ratio have been shown to reduce mortality in hemorrhagic shock due to trauma. After institutuion of such a protocol at our institution we then retrospectively reviewed its implementation to assure timely initiation and appropriate allocation of resources.
Design:Retrospective review of 26 consective MTP initiations
Setting:Urban Level I Trauma Center
Patients:26 consective blunt/penetrating trauma patients, presenting to the trauma resuscitation area who had the initiation of a massive transfusion protocol based on their initial findings (physiologic and biochemical)
Interventions:Initiation of massive transfusion protocol with intent to transfuse FFP: PRBC's in 1:1 ratio
Main Outcome Measures:TASH Score (Trauma Associated Severe Hemorrhage Score); survival; products transfused (FFP, PRBC's, Platelets) in first 24 hours; time to first transfusion; proper/appropriate protocol request to blood bank
Results:Of the 26 protocol initiations only 10 request forms were filled out properly: most lacked "nature of the emergency". Initial physical signs/biochemical findings were inaccurate in predicting the need for massive transfusion (TASH score): three patients needed no blood products at all; 12 (46%) had > 10 units transfused; FFP:PRBC ratio was 0.5:1. Mortality was the same (50%) for those with and without "massive transfusion"
Conclusions: 1. Reconfiguring the protocol request form was necessary to enforce correct completion and blood banking requirements. 2. Massive transfusion protocol is no longeer initiated on the basis of a pre-hospital report: too inaccurate. 3. Patients requiring immediate transfusion are given two units PRBC's: those that require more are then considered for "massive transfusion protocol". 4. Patients with penetrating trauma require a different scoring system than "TASH" to accurately predict their need for massive transfusion.
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