Massive Transfusion Protocols: A Survey of Academic Medical Centers in the United States.

Abstract

Massive transfusion protocols (MTPs) have been adopted in many hospitals, and they may improve outcomes, as well as decrease the number of blood products transfused. However, there are no specific guidelines regarding the number and types of products that should be included in these protocols. MTPs may vary from hospital to hospital. A short, web-based survey was sent to blood bank medical directors at academic institutions to learn details about MTPs. A total of 107 survey requests were sent, and 56 were completed (52% response rate). All who responded had an MTP in place. Nearly all (n = 55, 98.2% [95% CI, 90.6%-99.7%]) base their protocol on delivery of fixed amounts and ratios of blood products, with only a minority incorporating any elements of laboratory-directed therapy. The most common target, red blood cell (RBC):plasma ratio, is 1:1 (n = 39, 69.9% [95% CI, 56.7%-80.1%] of respondents). The majority (n = 36, 64.3% [95% CI, 51.2%-75.6%]) provide 6 or more units of red blood cells in the first MTP packet. One-hundred percent of survey respondents had an MTP in place. Despite a lack of published guidelines regarding MTPs, the survey results demonstrated substantial uniformity in numbers of products and target transfusion ratios.