Rapid Release Protocol Optimizes Product Utilization Compared With Massive Transfusion Protocol in Selected Patients.

BACKGROUND

While massive transfusion protocols (MTPs) are effective means of expeditiously delivering blood products to patients with exsanguinating hemorrhage, activation often occurs in cases with small blood volume deficits, leading to product wastage and overtransfusion. We sought to determine whether the additional implementation of a new protocol (called Rapid Release [RR]), which uses less resources, would result in decrease in blood product wastage. We hypothesized that RR would result in the reservation of MTPs for sicker patients and that blood product wastage would decrease.

METHODS

All MTP activations 1.5 y pre-RR and 1.5 y post-RR were analyzed. Compared with MTP (six units packed red blood cells [pRBCs], six units fresh frozen plasma [FFP], six units platelets), RR only releases four units pRBCs and one unit FFP per activation. MTP resource utilization and wastage was compared before and after RR in trauma and nontrauma populations. P ≤ 0.05 was considered significant.

RESULTS

One hundred nine MTPs were activated pre- (n = 48) to post-RR (n = 61), with 69 RRs activated in the post-RR period. Of these 69 RRs, 10 (14.5%) were eventually upgraded to MTP. Compared with the pre-RR group, significantly higher transfusion rates were observed for FFP and platelets. FFP wastage increased (pre: 0.65 ± 1.78 versus post: 3.46 ± 4.29; P < 0.001) over the study duration with no differences between the trauma and nontrauma populations.

CONCLUSIONS

Contrary to our hypothesis, institution of the RR protocol resulted in higher mean wastage of FFP per activation despite the appropriateness of the RR protocol. Further efforts are warranted to refine the MTP to increase efficiency.