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Massive transfusion policies at trauma centers participating in the American College of Surgeons Trauma Quality Improvement Program

Camazine, Maraya N.; Hemmila, Mark R. MD; Leonard, Julie C. MD, MPH; Jacobs, Rachel A.; Horst, Jennifer A. MD; Kozar, Rosemary A. MD, PhD; Bochicchio, Grant V. MD, MPH; Nathens, Avery B. MD; Cryer, Henry M. MD, PhD; Spinella, Philip C. MD

Journal of Trauma and Acute Care Surgery: June 2015 - Volume 78 - Issue 6 - p S48–S53
doi: 10.1097/TA.0000000000000641
Original Articles

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.

CONCLUSION 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.

Supplemental digital content is available in the text.

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.

Submitted: February 16, 2015, Accepted: March 2, 2015.

This article was presented as a poster at The American Association for the Surgery of Trauma Conference, and the content was presented at the 4th Annual Remote Damage Control Resuscitation Symposium of the Trauma Hemostasis and Oxygenation Research Network, June 9–11, 2014, in Bergen, Norway.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (

Address for reprints: Philip C. Spinella, MD, Campus Box 8116, 10th Floor NWT 1 Children’s Place, St. Louis, MO 63110; email:

© 2015 Lippincott Williams & Wilkins, Inc.