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Massive transfusion protocol optimization

Smith, M.
Briggs, J.
Coker, R.
Blankenship, D.
Schiesel, M.
Cannon, M.
Murray, K.
Pritchett, J.
Hemorrhage is the leading cause of mortality in trauma, accounting for up to 80% of intraoperative trauma mortalities and nearly half of the deaths that occur within 24 hours of traumatic injury. The timely and appropriate administration of blood products in hemorrhage control is paramount to adequate resuscitation efforts. Given the need for rapid delivery of products, appropriate product infusion ratios, and adjunctive therapies for control of hemorrhage and anticoagulation reversal, it is essential that facilities have and maintain a Massive Transfusion Protocol. The goal of this project was to create a Massive Transfusion Protocol for our facility that incorporated current literature, involved buy-in from all involved departments, and optimized blood product ordering and delivery in the emergency setting. To this end, a literature search was performed, and a protocol was drafted which focused on single entry point ordering, and automated product delivery until massive transfusion was halted. Elective orders were also incorporated for easy requesting of coagulation reversal agents and pro-clotting factors. The final draft of the protocol was submitted to the hospital transfusion committee for approval and then incorporated into an EHR order set. Staff training was performed in all involved departments before deployment. Outcome measurement is ongoing but it is anticipated that this updated protocol will decrease time between disposition of major bleed and arrival of blood products at the bedside. It is also expected that this protocol will decrease the amount of crystalloid products given to major bleeding patients by increasing efficiency of blood product delivery.