Massive Transfusion Protocol (MTP)

[Alan Hoffstadter]

In order to be accredited as a Level I Trauma Center by the American College of Surgeons, the center must have a Massive Transfusion Protocol. This concept, which appears to distill down to a of a mix of products, prepared and issued as a bolus or "cycle," was discouraged in the past as a "****tail" approach. Now it has become of interest in light of the very obvious need for adequate transfusion service response to severe traumatic injury, and the fact that it is a required element for ACS accreditation.

We have been struggling for about three years to tweak our MTP to satisfy our trauma surgeons' demands/patients' needs. To their credit, the the surgeons have been very judicious in their choices to invoke this process, but our product mix is not quite right yet. (Yes, we know the products ordered should be tailored to the patient, but the MTP is designed to try to get ahead of some of those needs).

Has anyone else within the Forum been struggling with this issue, and if so, have they found a formula that meets with their surgeons' approval where it counts, in the trauma bay and in the O.R.?

We are obliged for your input.

[Lcsmrz]

Boy, am I glad not to be in a Trauma I center anymore ...

We found our Lead Techs did a wonderful job second-guessing the situation, basing decisions on the surgeon's name and the initial lab results. We wasted very few components and always seem to have more products on the way when the order for more arrived.

But we had no set protocol, which would have probably hindered decision-making when it was needed most!

[donellda]

We are a level 2 trauma center and our trauma doctors came up with a protocol that works fairly well. If a trauma is going to be massively transfused we provide the ER or OR with what we call a "red chest" which is a cooler with 6 O negative packed red cells or 6 O positive red cells for males in the case of an O negative shortage packed with ice pillows. The ER or OR call the blood bank and tell us they want the red chest. We get the units ready for issue and the ER or OR comes to the blood bank with an emergency release form and patient labels. The labels are attached to the units and to the top copy of the unit tag. We keep the second copy. We thaw 4 units of AB FFP and make sure that we have platelets available (not pooled) for the trauma. Once a specimen is received, we type and screen, and crossmatch the units. We also have another 4 to 6 units ready. At 10 units the patient is consider massively transfused and we no longer crossmatch. If the plasma that was thawed is not used for the trauma we, hopefully, will be able to use them for another patient. Other products are ordered and provided as needed. We use the "red chest" several times a week at our facility.