title: A massive transfusion protocol to decrease blood component use and costs.
abstract: 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.
authors.affiliation: Departments of Surgery, Division of Burn, Trauma, and Critical Care, University of Texas Southwestern Medical School, Dallas 75390, USA.
authors.forename: Terence
authors.initials: T
authors.lastname: O'Keeffe
authors.forename: Majed
authors.initials: M
authors.lastname: Refaai
authors.forename: Kathryn
authors.initials: K
authors.lastname: Tchorz
authors.forename: John E
authors.initials: JE
authors.lastname: Forestner
authors.forename: Ravi
authors.initials: R
authors.lastname: Sarode
mesh_terms: 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
chemical_list: D003029:Coagulants; D015942:Factor VIIa