A Massive Transfusion Protocol to Decrease Blood Component Use and Costs

Abstract

Hypothesis: A massive transfusion protocol (MTP) decreases the use of blood components, as well as turnaround times, costs, and mortality.Design: Retrospective before-and-after cohort study.Setting: Academic level I urban trauma center.Patients and Methods: Blood component use was compared in 132 patients during a 2-year period following the implementation of an MTP; 46 patients who were treated the previous year served as historical control subjects.Intervention: Introduction of an MTP that included recombinant factor VIIa for patients with exsanguinating hemorrhage. Main Outcome Measures:The amount of each blood component transfused, turnaround times, blood bank and hospital charges, and mortality rates.Results: After introduction of the MTP, there was a significant decrease in packed red blood cells, plasma, and platelet use. The turnaround time for the first shipment was less than 10 minutes, and the time between the first and second shipments was reduced from 42 to 18 minutes, compared with historical controls. The decreased use of blood products represented a savings of $2270 per patient or an annual savings of $200 000, despite increased costs for recombinant factor VIIa. There was no difference in mortality in either group; it remained around 50%. Thromboembolic complications did not increase, despite a significant increase in the use of recombinant factor VIIa. Conclusions:The MTP resulted in a reduction in the use of blood components with improved turnaround times and significant savings. Mortality was unaffected. The use of recombinant factor VIIa did not increase thromboembolic complications in these patients.

Blood Components Consumption Model in China: A Single-center Investigation with-in 11-years Interval

“…These changes in principle consequently reduced risks associated with transfusion practices [16]. Moreover, blood components administration reduced the economic burden and conserved blood recourse [17].…”

The impact of a massive transfusion protocol (1:1:1) on major hepatic injuries: Does it increase abdominal wall closure rates?

“…1,[21][22][23][24] Prior to the implementation of a formalized high plasma MTP (Table 1), mortality for patients who required a massive transfusion (≥ 10 units of RBCs) following grade 3, 4 or 5 hepatic injuries at our institution was 60%, 46% and 71%, respectively. Given associated patient ISS of 31, 26 and 29, Total PRBC units, < 6 h 28 20…”

“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] While the effect on overall mortality in the civilian population is still debated, [21][22][23][24] massive resuscitations with high plasma:packed red blood cell (RBC) ratios remain promising for addressing the early coagulopathy 25 and acidosis frequently associated with life-threatening injury. 10 Additional benefits of a formal MTP include earlier administration of blood products during the resuscitation phase, improved overall efficiency, decreased total blood product use during a patient's hospital stay and a substantial economic savings.…”

“…10 Additional benefits of a formal MTP include earlier administration of blood products during the resuscitation phase, improved overall efficiency, decreased total blood product use during a patient's hospital stay and a substantial economic savings. 24 Concurrent to the initiation of MTP blood component therapy, the concept of damage control resuscitation also incorporates principles of reduced crystalloid delivery, permissive hypotension and immediate operative and/or angiographic hemorrhage control. This constellation of techniques is directed at patients who present in physiologic extremis (pH ≤ 7.1, base deficit ≥ 12.5, and/or core temperature ≤ 34°C).…”

Blood Loss and Massive Transfusion in Patients Undergoing Major Oncological Surgery: What Do We Know?

“…Moreover, an unknown percentage of these patients are at risk for massive blood transfusion, which is commonly defined as the transfusion of more that 10 units of packed red blood cells in a 24-hour period [8]. Massive blood transfusions during oncological surgery can be anticipated or unexpected.…”