Background/Case Studies: We manage a transfusion service at a hospital with a very busy Level I Trauma Center. Our Level I trauma protocol initially required delivery of coolers with 4 RBCs and 2 thawed plasmas to the trauma bay for every Level I patient that was enroute to the hospital in case immediate transfusion was needed upon arrival. If the blood in the initial cooler was transfused, the trauma team activated the massive transfusion protocol if additional blood was needed. In 2019, a refrigerator was placed in the trauma bay and stocked with 2 RBCs to enable immediate transfusion for patients who arrived before the blood cooler could be delivered. The protocol for delivering the initial cooler remained in place. In January 2022, we replaced the blood components in the refrigerator with two units of Low Titer O Positive Whole Blood (LTOWB) to streamline resuscitation efforts. In March 2023, we increased the number of LTOWB units to 4 and reduced the RBCs and Plasma in the cooler to 2 each. By June 2024, the Trauma Department determined that delivery of the initial cooler was no longer necessary since patients rarely needed all 4 LTOWB units. We analyzed six years of transfusion data to assess the impact of these changes on blood product utilization for trauma patients.
Study
Design/Methods: We analyzed trauma transfusion data, tracking coolers delivered, refrigerator units transfused, and total blood component usage. We compared trends across implementation phases of our LTOWB program.
Results/Findings: Our data from January 2019 through December 2024 showed that after LTOWB implementation in 2022, traditional component usage from the refrigerator dropped dramatically (from 45 units in 2021 to zero in 2022, with just 4 units in 2023 and none in 2024) while LTOWB utilization rose significantly (116 units in 2022, increasing to 253 in 2023, and 261 in 2024). (See Table 1) Concurrently, overall RBC usage dropped 43% and plasma usage decreased 39% from 2022 to 2023. Blood access remained adequate despite eliminating routine cooler delivery. Conclusions: LTOWB implementation and subsequent expansion of LTOWB availability in our trauma bay largely replaced component therapy in the trauma refrigerator while significantly reducing overall component blood usage. This shift not only streamlined our workflow but substantially changed our resuscitation approach. The complete transition to LTOWB in the trauma refrigerator effectively replaced resource-intensive cooler delivery for incoming trauma patients. Future studies should evaluate clinical outcomes and potential cost savings from this practice change.
