Implementation of a massive transfusion protocol: A single trauma center experience from South Korea

BACKGROUND: Massive transfusion (MT) is traditionally defined as transfusion of more than 10 units of red blood cells (RBCs) within the first 24 h after admission. The aim of this study is to analyze the trend of MT in regional trauma center including ratio of fresh frozen plasma (FFP) and packed RBC. METHODS: Retrospective data were driven from 2014 to 2016. A total of 185 patients who received more than 10 packed RBC units within the first 24 h after admission were included in the study. We analyzed transfusion requirements for each time interval 4 h and 24 h after admission. Moreover, we compared transfusion characteristics between survival and non-survival group, between high FFP:RBC group (≥1: 2) and low FFP:RBC group (<1: 2), and between the first half and latter half period. RESULTS: There was a trend for improvement in the FFP:RBC ratio after applying the MT protocol. The FFP:RBC ratio increased from 1:1.7 to 1:1.4 within 24 h after arrival. The time to first transfusion was shortened (137–106 min). Mortality was lower in high FFP:RBC group than that of low FFP:RBC group. CONCLUSION: In our study, the MT protocol improved the FFP:RBC ratio. A higher FFP:RBC ratio also led to an improvement in the mortality rate in MT patients.