A massive transfusion protocol to decrease blood component use and costs.
OBJECTIVE
A massive transfusion protocol (MTP) decreases the use of blood components, as well as turnaround times, costs, and mortality.


METHODS
Retrospective before-and-after cohort study.


METHODS
Academic level I urban trauma center.


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.


METHODS
Introduction of an MTP that included recombinant factor VIIa for patients with exsanguinating hemorrhage.


METHODS
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.
O'Keeffe
Terence
T
Departments of Surgery, Division of Burn, Trauma, and Critical Care, University of Texas Southwestern Medical School, Dallas 75390, USA.
Refaai
Majed
M
Tchorz
Kathryn
K
Forestner
John E
JE
Sarode
Ravi
R
D000328:Adult; D016913:Blood Component Transfusion / Q000191:economics; D002985:Clinical Protocols; D003029:Coagulants / Q000627:therapeutic use*; D015942:Factor VIIa / Q000627:therapeutic use*; D006470:Hemorrhage / Q000188:drug therapy* / Q000453:epidemiology / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014193:Trauma Centers; D014505:Urban Population; D014947:Wounds and Injuries / Q000150:complications
D003029:Coagulants; D015942:Factor VIIa