TY - JOUR
T1 - Real-time performance improvement optimizes damage control resuscitation best practice adherence
T2 - Results of a pilot prospective observational study
AU - Schmulevich, Daniela
AU - Geng, Zhi
AU - Joergensen, Sarah M.
AU - McLauchlan, Nathaniel R.
AU - Winter, Eric
AU - Zone, Alea
AU - Bishop, Kathleen E.
AU - Hinkle, Alyson
AU - Holland, Sara
AU - Cacchione, Pamela Z.
AU - Fox, Erin E.
AU - Abella, Benjamin S.
AU - Meador, Christopher L.
AU - Wade, Charles E.
AU - Hynes, Allyson M.
AU - Cannon, Jeremy W.
N1 - Publisher Copyright:
© 2024 The Author(s). Transfusion published by Wiley Periodicals LLC on behalf of AABB.
PY - 2024/9
Y1 - 2024/9
N2 - Background: Maintaining balanced blood product ratios during damage control resuscitation (DCR) is independently associated with improved survival. We hypothesized that real-time performance improvement (RT-PI) would increase adherence to DCR best practice. Study Design and Methods: From December 2020–August 2021, we prospectively used a bedside RT-PI tool to guide DCR in severely injured patients surviving at least 30 min. RT-PI study patients were compared to contemporary control patients at our institution and historic PROMMTT study patients. A subset of patients transfused ≥6 U red blood cells (RBC) in 6 h (MT+) was also identified. The primary endpoint was percentage time in a high ratio range (≥3:4) of plasma (PLAS):RBC and platelet (PLT):RBC over 6 h. Secondary endpoints included time to massive transfusion protocol activation, time to calcium and tranexamic acid (TXA) dosing, and cumulative 6-h ratios. Results: Included patients (n = 772) were 35 (24–51) years old with an Injury Severity Score of 27 (17–38) and 42% had penetrating injuries. RT-PI (n = 10) patients spent 96% of the 6-h resuscitation in a high PLAS:RBC range, no different versus CONTROL (n = 87) (96%) but more than PROMMTT (n = 675) (25%, p <.001). In the MT+ subgroup, optimal PLAS:RBC and PLT:RBC were maintained for the entire 6 h in RT-PI (n = 4) versus PROMMTT (n = 391) patients for both PLAS (p <.001) and PLT ratios (p <.001). Time to TXA also improved significantly in RT-PI versus CONTROL patients (27 min [22–31] vs. 51 min [29–98], p =.035). Conclusion: In this prospective study, RT-PI was associated with optimized DCR. Multicenter validation of this novel approach to optimizing DCR implementation is warranted.
AB - Background: Maintaining balanced blood product ratios during damage control resuscitation (DCR) is independently associated with improved survival. We hypothesized that real-time performance improvement (RT-PI) would increase adherence to DCR best practice. Study Design and Methods: From December 2020–August 2021, we prospectively used a bedside RT-PI tool to guide DCR in severely injured patients surviving at least 30 min. RT-PI study patients were compared to contemporary control patients at our institution and historic PROMMTT study patients. A subset of patients transfused ≥6 U red blood cells (RBC) in 6 h (MT+) was also identified. The primary endpoint was percentage time in a high ratio range (≥3:4) of plasma (PLAS):RBC and platelet (PLT):RBC over 6 h. Secondary endpoints included time to massive transfusion protocol activation, time to calcium and tranexamic acid (TXA) dosing, and cumulative 6-h ratios. Results: Included patients (n = 772) were 35 (24–51) years old with an Injury Severity Score of 27 (17–38) and 42% had penetrating injuries. RT-PI (n = 10) patients spent 96% of the 6-h resuscitation in a high PLAS:RBC range, no different versus CONTROL (n = 87) (96%) but more than PROMMTT (n = 675) (25%, p <.001). In the MT+ subgroup, optimal PLAS:RBC and PLT:RBC were maintained for the entire 6 h in RT-PI (n = 4) versus PROMMTT (n = 391) patients for both PLAS (p <.001) and PLT ratios (p <.001). Time to TXA also improved significantly in RT-PI versus CONTROL patients (27 min [22–31] vs. 51 min [29–98], p =.035). Conclusion: In this prospective study, RT-PI was associated with optimized DCR. Multicenter validation of this novel approach to optimizing DCR implementation is warranted.
UR - http://www.scopus.com/inward/record.url?scp=85200024172&partnerID=8YFLogxK
U2 - 10.1111/trf.17970
DO - 10.1111/trf.17970
M3 - Article
C2 - 39072759
AN - SCOPUS:85200024172
SN - 0041-1132
VL - 64
SP - 1692
EP - 1702
JO - Transfusion
JF - Transfusion
IS - 9
ER -