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Transfusion Service - Evidence Based Medical Practices

(P-TS-66) Implementation of Low Titer O Whole Blood for Initial Resuscitation upon Arrival in Trauma: Impact on Turnaround Time

Sunday, October 26, 2025
12:00 PM - 1:00 PM  PT
Background/Case Studies: Rapid turnaround time and balanced transfusion ratios of red blood cells (RBCs) to plasma have been associated with improved patient outcomes in trauma. At our level 1 trauma center, the service level agreement is for blood to arrive in the Emergency Department (ED) within ten minutes of a Trauma 1 activation. Our legacy protocol used component therapy (CT) for prehospital transfusion and initial resuscitation for Trauma 1 activations upon hospital arrival. Implementation of two Low Titer O Whole Blood (LTOWB) units upon ED arrival for Trauma 1 activations was hypothesized to improve turnaround times (TAT).

Study

Design/Methods: A retrospective review of 426 Trauma 1 activation turnaround times was conducted between January 1, 2023 and October 31, 2024. The pre-intervention (control) period, when the legacy protocol was used, was January 1, 2023 through October 10, 2023 and the intervention period was October 11, 2023 through October 31, 2024. Median and mean turnaround times were calculated from the receipt time of the Trauma 1 activation page in the Blood Bank to the recorded product arrival time in the ED (Overall TAT). Median and mean Blood Bank turnaround times were considered from the time of page to when the trauma pack was ready for pick-up. Component therapy (4:2, RBCs to Plasma) was issued for 173 events while two LTWOB units were issued for 254 Trauma 1 activations.



Results/Findings: The median and mean blood product arrival times to the ED for Trauma 1 activations improved when two units of LTOWB were issued compared with component therapy (4:2, RBCs to Plasma). Figure 1 shows the mean Overall TAT; CT took a mean of 8.9 minutes and LTOWB a mean of 7.6 minutes to arrive to the Emergency Department (P-Value < 0.001). The Overall TAT was evaluated at the 95th percentile due to service level agreements between the laboratory and hospital; CT took a mean of 15.25 minutes and LTOWB a mean of 11.15 minutes. Blood Bank turnaround time improved from a mean of 6.6 minutes with CT to a mean of 4.3 minutes when preparing two units of LTOWB (P-Value < 0.001).

Conclusions: In this retrospective study, the use of LTOWB was associated with quicker blood arrival times to the Emergency Department compared with issuing CT in a 4:2 ratio (RBCs to Plasma). Impact on clinical patient outcomes was not evaluated.