Johnson, Frances

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Background: Traumatic injury is the leading cause of death for individuals under the age of 45 years old, regardless of race, origin, or sex (CDC, 2019). Among patients who sustain traumatic injury, hemorrhage remains the leading cause of death (American College of Surgeons [ACS], 2014). Hemodynamic stability may be achieved through administration of blood products such as packed red blood cells (PRBC), plasma, and platelets (PTL). Patients with severe exsanguination may require administration of blood products in large quantities, also known as a massive blood transfusion (MBT).

Local Problem: Nationally, traumatic injury accounts for over 150,000 deaths annually (American Association for the Surgery of Trauma, 2020). Management of MBT at trauma facilities as well as massive transfusion protocols (MTP) vary among trauma centers. While traumatic injury and exsanguination remains a burden on the healthcare system, there is no standardized approach to facilitate administration of MBT. Hypocalcemia can result as citrate is used as a preservative in blood products, causing chelation of endogenous calcium and placing the patient at risk for tetany, cardiac arrythmias, acidosis, worsening coagulopathy, and death. Intervention: To evaluate how level 1 trauma facilities manage MBT, to determine if a protocol is utilized, and to evaluate perceptions and experiences related to MBT practice, a qualitative study was performed. Utilizing interpretive description, a survey was administered to healthcare providers working within either the trauma department or blood bank.

Results: Massive transfusion protocol (MTP) initiation and MBT administration vary across the board. The approach to laboratory management as well as calcium monitoring and replacement is highly variable among level 1 trauma centers.

Conclusion: Evaluating how level 1 trauma centers manage MBT practices has shown the need for further research to promote the development of a standardized MTP with the goal of improving outcomes among trauma patients.

Search Terms: Massive blood transfusion, massive transfusion protocol, hemorrhagic shock, MBT and trauma, MBT and hypocalcemia.