title: Massive transfusion policies at trauma centers participating in the American College of Surgeons Trauma Quality Improvement Program.
abstract: BACKGROUND
  Massive transfusion protocols (MTPs) have been developed to implement damage control resuscitation (DCR) principles. A survey of MTP policies from American College of Surgeons Trauma Quality Improvement Program (ACS-TQIP) participants was performed to establish which MTP activation, hemostatic resuscitation, and monitoring aspects of DCR are included in the MTP guidelines.
  
  
  METHODS
  On October 10, 2013, ACS-TQIP administration administered a cross-sectional electronic survey to 187 ACS-TQIP participants.
  
  
  RESULTS
  Seventy-one percent (132 of 187) of responses were analyzed, with 62% designated as Level I and 38% designated as Level II ACS-TQIP trauma centers. Sixty-nine percent of sites indicated that they have plasma immediately available for MTP activation. By policy, in the first group of blood products administered, 88% of sites target high (≥1:2) plasma-to-red blood cell (RBC) ratios and 10% target low ratios. Likewise, 79% of sites target high platelet-to-RBC ratios and 16% target low ratios. Eighteen percent of sites reported incorporating point-of-care thromboelastogram into MTP policies. The most common intravenous hemostatic adjunct incorporated into MTPs was tranexamic acid (49%). Thirty-four percent of sites reported that some or all of their emergency medical service agencies have the ability to administer blood products or hemostatic agents during prehospital transport. There were minimal differences in MTP policies or capabilities between Level I and II sites.
  
  
  CONCLUSIONS
  The majority of ACS-TQIP participants reported having MTPs that support the use of DCR principles including high plasma-to-RBC and platelet-to-RBC ratios. Immediate availability of plasma and product use by emergency medical services are becoming increasingly common, whereas the incorporation of point-of-care thromboelastogram into MTP policies remains low.
authors.affiliation: From the Divisions of Critical Care (M.N.C., R.A.J., P.C.S.) and Emergency Medicine (J.A.H.), Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri; Department of Surgery (M.R.H.), University of Michigan Medical School, Ann Arbor, Michigan; Department of Pediatrics (J.C.L.), Nationwide Children's Hospital, Columbus, Ohio; Shock Trauma Center (R.A.K.), University of Maryland, Baltimore, Maryland; Department of Surgery (G.V.B.), Washington University in St. Louis, St. Louis, Missouri; Department of Surgery (A.B.N.), Sunnybrook Health Sciences Center and the University of Toronto, Toronto, Ontario, Canada; and Department of Surgery (H.M.C.), University of California, Los Angeles, Los Angeles, California.
authors.forename: Maraya N
authors.initials: MN
authors.lastname: Camazine
authors.forename: Mark R
authors.initials: MR
authors.lastname: Hemmila
authors.forename: Julie C
authors.initials: JC
authors.lastname: Leonard
authors.forename: Rachel A
authors.initials: RA
authors.lastname: Jacobs
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Horst
authors.forename: Rosemary A
authors.initials: RA
authors.lastname: Kozar
authors.forename: Grant V
authors.initials: GV
authors.lastname: Bochicchio
authors.forename: Avery B
authors.initials: AB
authors.lastname: Nathens
authors.forename: Henry M
authors.initials: HM
authors.lastname: Cryer
authors.forename: Philip C
authors.initials: PC
authors.lastname: Spinella
mesh_terms: D000933:Antifibrinolytic Agents / Q000008:administration & dosage; D001803:Blood Transfusion / Q000592:standards*; D002985:Clinical Protocols; D006490:Hemostatics / Q000008:administration & dosage; D006801:Humans; D016134:Organizational Policy; D019095:Point-of-Care Systems; D058996:Quality Improvement; D013916:Thrombelastography; D014148:Tranexamic Acid / Q000008:administration & dosage; D014193:Trauma Centers / Q000458:organization & administration*
chemical_list: D000933:Antifibrinolytic Agents; D006490:Hemostatics; D014148:Tranexamic Acid