title: A major haemorrhage protocol improves the delivery of blood component therapy and reduces waste in trauma massive transfusion.
abstract: BACKGROUND
  Major haemorrhage protocols (MHP) are required as part of damage control resuscitation regimens in modern trauma care. The primary objectives of this study were to ascertain whether a MHP improved blood product administration and reduced waste compared to traditional massive transfusion protocols (MTP).
  
  
  METHODS
  Datasets on adult trauma admissions 1 year prior and 1 year post implementation of a MHP at a Level 1 trauma centre were obtained from the trauma registry. Demographic and clinical data were collected prospectively including mechanism of injury, physiological observations, ICU admission and length of stay. The volume of blood components (packed red blood cells, platelets, cryoprecipitate and fresh frozen plasma) issued, transfused, returned to stock and wasted within the first 24h was gathered retrospectively.
  
  
  RESULTS
  Over the 2-year study period 2986 patient records were available for analysis. 40 patients required a 10+ Units of packed red blood ells transfusion in the MTP group vs. 56 patients post MHP implementation. The administration of blood component therapy improved significantly post MHP implementation. FFP:PRBC transfusion improved from 1:3 to 1:2 (p<0.01) and CRYO:PRBC improved from 1:10 to 1:7 (p<0.05). We reported a significant reduction in the waste of platelets from 14% to 2% (p<0.01). Outcomes had improved: Median hospital length of stay was reduced from 54 days to 26 days (p<0.05).
  
  
  CONCLUSIONS
  Implementation of a MHP results in improved delivery of blood components and a reduction in the waste of blood products compared to the older model of MTP. In combination with educational programmes MHP can significantly improve blood product administration and patient outcomes in trauma haemorrhage.
  
  
  METHODS
  Level III diagnostic test study.
authors.affiliation: Trauma Sciences, Blizard Institute Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK. sirat.khan@bartsandthelondon.nhs.uk
authors.forename: Sirat
authors.initials: S
authors.lastname: Khan
authors.forename: Shubha
authors.initials: S
authors.lastname: Allard
authors.forename: Anne
authors.initials: A
authors.lastname: Weaver
authors.forename: Colin
authors.initials: C
authors.lastname: Barber
authors.forename: Ross
authors.initials: R
authors.lastname: Davenport
authors.forename: Karim
authors.initials: K
authors.lastname: Brohi
mesh_terms: D019985:Benchmarking; D016913:Blood Component Transfusion / Q000379:methods*; D002985:Clinical Protocols; D005260:Female; D006470:Hemorrhage / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012151:Resuscitation / Q000193:education / Q000379:methods*; D014193:Trauma Centers; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology; D014947:Wounds and Injuries / Q000150:complications / Q000453:epidemiology / Q000628:therapy*