Neely Hudson, Pharm.D., BCPS
Emergency Medicine Clinical Pharmacy Specialist
Baptist St. Anthony's Hospital, United States
Disclosure information not submitted.
Ariel Santos, MD, MPH, FCCM
MD, MPH, FACS, FRCSC, FCCM
Texas Tech University Health Science Center
Lubbock, Texas
Disclosure information not submitted.
Maegan Whitworth, Pharm.D., BCPS, BCCCP
Clinical Pharmacy Manager
Baptist St. Anthony's Hospital, United States
Disclosure information not submitted.
Kripa Shrestha, MBBS, MS, MPH
Research Associate
Texas Tech University Health Sciences Center Department of Surgery, United States
Disclosure information not submitted.
Robyn Richmond, MD, FACS
Assistant Professor
Texas Tech University Health Sciences Center Department of Surgery, United States
Disclosure information not submitted.
Amber Tucker, MSN, RN
Director, Trauma & Burn Service Department
University Medical Center, United States
Disclosure information not submitted.
Kara Chambers, MSN, RN
Trauma and Burn Pediatric Performance Improvement Coordinator
University Medical Center, United States
Disclosure information not submitted.
Charles Seifert, Pharm.D., FCCP
Senior Execute Associate Dean
Texas Tech University Health Sciences Center School of Pharmacy, United States
Disclosure information not submitted.
Title: Evaluation of Thromboelastography Utilization During Massive Transfusion Protocol Activations
Introduction/Hypothesis: Hemorrhage is the most common cause of death within the first hour of arrival to a trauma center. Massive transfusion protocol (MTP) activations include the administration of blood products, including packed red blood cells (pRBC), fresh frozen plasma (FFP), platelets (PL), and medications, as 4-factor prothrombin complex concentrates (4F-PCC). Thromboelastography (TEG) allows targeted blood product administration. The goal of this study is to examine if utilizing TEG during MTP activations in trauma patients is associated with reduced utilization of composite blood products.
Methods: A retrospective review was conducted to evaluate the effects of TEG use vs. no TEG use during MTP activation from January 1, 2018-December 31, 2020. A cohort of patients registered in Trauma Registry (TR) were identified for sub analysis. The composite units of blood product and 4F-PCC administration along with clinical outcomes were compared.
Results: Of 308 MTP activation, only 137 patients met the inclusion criteria (TEG=47, no TEG= 90) of which 90 were recorded in TR (TEG=28, no TEG=62). The blood product utilization (in units) was high in TEG group (23 vs. 15, p=0.004) with increased utilization of pRBC (13 vs 9, p=0.036); FFP (8 vs 5.5, p=0.002) and PL (2 vs 1, p=0.002). Similarly, the composite units of blood products utilization was also high in TR cohort. No significant difference in TEG utilization for in-hospital mortality (46.8% vs. 52.2%, p=0.547) or 24-hour mortality (23.4% vs. 38.9%, p=0.068) were seen neither were noted for TR cohort for in-hospital mortality (17.9% vs. 19.4%, p=0.642) and 24-hour mortality (7.1% vs. 12.9%, p=0.644). Administration of 4F-PCC (n=30) was noted to be associated with an increased risk of in-hospital mortality in the entire cohort (76.7% vs. 42.9%, p=0.001) and the TR cohort (n=21) (80.1% vs. 36.2%, p=< 0.001).
Conclusions: Utilization of TEG during MTP activation was not associated with decreased blood product utilization or improved patient outcomes. More units of total blood products were utilized and was associated with an increased in in-hospital mortality in patients receiving 4F-PCC.