Van Gent Jan-Michael, Bavishi Devi, Clements Thomas W, Dickey James B, Hobbs Rhonda, Bai Yu, Kao Lillian S, Cotton Bryan A
From the Department of Surgery, McGovern Medical School, Houston, TX (Van Gent, Bavishi, Clements, Dickey, Kao, Cotton).
The Center for Translational Injury Research, Houston, TX (Van Gent, Clements, Kao, Cotton).
J Am Coll Surg. 2025 Apr 1;240(4):578-585. doi: 10.1097/XCS.0000000000001282. Epub 2025 Mar 17.
In 2012, TQIP guidelines for massive transfusion protocols (MTPs) recommended delivery of blood product coolers within 15 minutes. Subsequent work found that every minute delay in cooler arrival was associated with a 5% increased risk of mortality. We sought to assess the impact and sustainability of quality improvement (QI) interventions on time to MTP cooler delivery and their association with trauma patient survival.
In 2009, a QI process was initiated to improve MTP activation and delivery of blood (QI 1). In 2012, TQIP Best Practice Guidelines were implemented at our facility (QI 2). In 2016, we implemented measures to activate our MTP based off prehospital Assessment of Blood Consumption score higher than 1 or any prehospital blood transfusion (QI 3). All patients receiving MTP from January 2009 and December 2022 were included. Patients were compared by year and their respective QI interventions. Primary outcome was time from MTP activation to delivery of the first cooler. A regression model was then constructed to evaluate time to the first cooler on outcomes.
During the study period, 52,328 trauma patients were admitted, with 4,313 MTP trauma activations. With each subsequent QI intervention, time to first MTP cooler and mortality both decreased, whereas injury severity increased. Multivariate regression noted that when the time to first cooler could be kept to 8 minutes or less, mortality was reduced by 35% (odds ratio 0.64, 95% CI 0.44 to 0.92; p = 0.019).
With increased MTP activations, delivery of the first cooler was faster and mortality improved. Keeping cooler times under 8 minutes was associated with increased survival. The measurement and monitoring of "door-to-cooler" time should be considered as a metric to assess performance and delivery of institutional MTP.
2012年，创伤质量改进计划（TQIP）关于大量输血方案（MTP）的指南建议在15分钟内送达血液制品冷却器。随后的研究发现，冷却器到达时间每延迟一分钟，死亡风险就会增加5%。我们试图评估质量改进（QI）干预措施对MTP冷却器送达时间的影响和可持续性，以及它们与创伤患者生存率的关联。
2009年，启动了一项QI流程以改善MTP的启动和血液输送（QI 1）。2012年，我们的机构实施了TQIP最佳实践指南（QI 2）。2016年，我们实施了基于院前血液消耗评分高于1或任何院前输血来启动MTP的措施（QI 3）。纳入了2009年1月至2022年12月期间所有接受MTP的患者。按年份及其各自的QI干预措施对患者进行比较。主要结局是从MTP启动到第一个冷却器送达的时间。然后构建一个回归模型来评估第一个冷却器送达时间对结局的影响。
在研究期间，52328例创伤患者入院，其中4313例激活了MTP创伤方案。随着后续每次QI干预，第一个MTP冷却器的送达时间和死亡率均下降，而损伤严重程度增加。多变量回归指出，当第一个冷却器的送达时间可保持在8分钟或更短时间时，死亡率降低了35%（比值比0.64，95%置信区间0.44至0.92；p = 0.019）。
随着MTP激活次数的增加，第一个冷却器的送达速度加快，死亡率降低。将冷却器送达时间控制在8分钟以内与生存率提高相关。应考虑将“门到冷却器”时间的测量和监测作为评估机构MTP性能和交付情况的一项指标。
