Improvement of treatment outcomes after implementation of a massive transfusion protocol

A level i trauma center experience

Andrew Nunn, Peter Fischer, Ronald Sing, Megan Templin, Michael Avery, A. Britton Christmas

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

We assessed the effectiveness of the implementation of an institutional massive transfusion protocol (MTP) for resuscitation with a 1:1:1 transfusion ratio of packed red blood cell (PRBC), fresh frozen plasma, and platelet units. In a Level I trauma center database, all trauma admissions (2004-2012) that received massive transfusions (‡10 units PRBCs in the first 24 hours) were reviewed retrospectively. Demographic data, transfusion ratios, and outcomes were compared before (PRE) and after (POST) MTP implementation in May 2008. Age, sex, and mechanism of injury were similar between 239 PRE and 208 POST trauma patients requiring massive transfusion. Transfusion ratios of fresh frozen plasma:PRBC and platelet:PRBC increased after MTP implementation. Among survivors, MTP implementation shortened hospital length of stay from 31 to 26 days (P = 0.04) and intensive care unit length of stay from 31 to 26 days (P = 0.02). Linear regression identified treatment after (versus before) implementation of MTP as an independent predictor of decreased ventilator days after adjusting for age, Glasgow Coma Scale, and chest Abbreviated Injury Score (P < 0.0001). Modest improvement in ratios likely does not account for all significant improvements in outcomes. Implementing a standardized protocol likely impacts automation, efficiency, and/or timeliness of product delivery.

Original languageEnglish (US)
Pages (from-to)394-398
Number of pages5
JournalAmerican Surgeon
Volume83
Issue number4
StatePublished - Apr 1 2017
Externally publishedYes

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Trauma Centers
Length of Stay
Erythrocytes
Wounds and Injuries
Blood Platelets
Thoracic Injuries
Glasgow Coma Scale
Automation
Mechanical Ventilators
Resuscitation
Intensive Care Units
Survivors
Linear Models
Demography
Databases
Therapeutics

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Improvement of treatment outcomes after implementation of a massive transfusion protocol : A level i trauma center experience. / Nunn, Andrew; Fischer, Peter; Sing, Ronald; Templin, Megan; Avery, Michael; Britton Christmas, A.

In: American Surgeon, Vol. 83, No. 4, 01.04.2017, p. 394-398.

Research output: Contribution to journalArticle

Nunn, A, Fischer, P, Sing, R, Templin, M, Avery, M & Britton Christmas, A 2017, 'Improvement of treatment outcomes after implementation of a massive transfusion protocol: A level i trauma center experience', American Surgeon, vol. 83, no. 4, pp. 394-398.
Nunn, Andrew ; Fischer, Peter ; Sing, Ronald ; Templin, Megan ; Avery, Michael ; Britton Christmas, A. / Improvement of treatment outcomes after implementation of a massive transfusion protocol : A level i trauma center experience. In: American Surgeon. 2017 ; Vol. 83, No. 4. pp. 394-398.
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