#OA4-AM25-SN-31 - Whole Blood for Trauma in a Low-Volume Level 1 Trauma Center: A Six-Year Review of Massive Transfusion Practices and Blood Product Utilization

Despite its designation as an American College of Surgeons Level 1 Adult Trauma Center, our 614-bed academic referral hospital manages relatively few trauma cases requiring massive transfusion (MTP). In mid-October 2024, whole blood (WB) was introduced to support trauma resuscitation (prehospital, emergency department (ED), and MTPs). WB MTP entailed a maximum of 2 lines of 5 WB units use before transitioning to component MTP. Early high discard rates of this costly and perishable product raised questions about whether WB use aligns with our institution’s transfusion needs. This study reviewed six years of trauma MTPs to evaluate transfusion practices, WB utilization, and opportunities for improved stewardship in a low-volume trauma center.

Study

Design/Methods:

MTP activations from April 2019 to April 2025 were reviewed using transfusion service logs, trauma flowsheets, and electronic medical records. Data abstracted included demographics, mechanism of injury, MTP product type (red blood cell- RBC, plasma, platelets, cryoprecipitate, and WB) and usage, ED fridge and prehospital use, mortality, and transfusion timelines. WB usage and wastage since its rollout were also evaluated.

Results/Findings:

A total of 125 trauma MTPs were identified: 122 with components (RBC, plasma, platelets, cryoprecipitate), and 11 with WB. Median age was 40 years (range 18–92), with 70% male. Most injuries were blunt (81%), predominantly motor vehicle-related. Median MTP RBC use was 6 units, with 45% using only one or fewer component MTP lines. In WB MTPs, 64% had 10 units issued but most MTPs had 2 units transfused. In 36% WB MTPs, there was early transition to component MTPs. Prehospital WB transfusion occurred in 2 of 13 patients requiring MTPs. Only 35% of WB issued for prehospital use were transfused over six months. WB was accessed from the ED fridge pre-MTP in 91% of WB MTPs. Post-MTP transfusions occurred in 24% (< 24h) and 43% ( >24h) of survivors. Mortality was 54%, with 25% occurring within 4 hours. Since WB introduction, 524 WB units were procured, 201 were transfused and 323 discarded—representing a 62% discard rate. Discards were highest in the first two months (up to 81%) but decreased over time as protocols evolved (Figure A).

Conclusions:

Our analysis reveals that despite Level 1 trauma center designation, true high-volume trauma MTPs are infrequent, and WB use remains limited and inefficient, with significant early wastage. Component therapy remains sufficient for most cases. These findings highlight the need to tailor WB inventory, improve targeting through real-time trauma triage, and establish clearer WB-to-component transition protocols. Institutions with similar trauma volumes should cautiously evaluate WB implementation to avoid waste and optimize patient care.