Impact of Massive Transfusion Activation on Time to Delivery of the First Cooler and Patient Survival: A Study of 4,313 Consecutive Activations.

Background: In 2012, TQIP guidelines for massive transfusion protocols (MTPs) recommended delivery of blood product coolers within 15 minutes. Subsequent work found that every minute delay in cooler arrival was associated with a 5% increased risk of mortality. We sought to assess the impact and sustainability of quality improvement (QI) interventions on time to MTP cooler delivery and their association with trauma patient survival.

Study Design: In 2009, a QI process was initiated to improve MTP activation and delivery of blood (QI 1). In 2012, TQIP Best Practice Guidelines were implemented at our facility (QI 2). In 2016, we implemented measures to activate our MTP based off prehospital Assessment of Blood Consumption score higher than 1 or any prehospital blood transfusion (QI 3). All patients receiving MTP from January 2009 and December 2022 were included. Patients were compared by year and their respective QI interventions. Primary outcome was time from MTP activation to delivery of the first cooler. A regression model was then constructed to evaluate time to the first cooler on outcomes.

Results: During the study period, 52,328 trauma patients were admitted, with 4,313 MTP trauma activations. With each subsequent QI intervention, time to first MTP cooler and mortality both decreased, whereas injury severity increased. Multivariate regression noted that when the time to first cooler could be kept to 8 minutes or less, mortality was reduced by 35% (odds ratio 0.64, 95% CI 0.44 to 0.92; p = 0.019).

Conclusions: With increased MTP activations, delivery of the first cooler was faster and mortality improved. Keeping cooler times under 8 minutes was associated with increased survival. The measurement and monitoring of "door-to-cooler" time should be considered as a metric to assess performance and delivery of institutional MTP.